Hospital AdministrationPolicy & Law

Nursing Homes Send More Medicaid to Hospitals

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A new study shows that individuals enrolled in Medicaid are 27 percent more likely to be sent to the hospital than individuals with private insurance – decisions that often result in higher costs of care and poor health outcomes. The inference is that nursing homes want to have their beds filled with more profitable patients and this is one-way to make room. 
“Nursing homes have an incentive to hospitalize some residents more often than others,” said Helena Temkin-Greener, Ph.D., M.P.H., senior author of the study and associate professor of Community and Preventive Medicine at the University of Rochester Medical Center. 

Another study published in the journal Medical Care Research and Review looks at hospitalization rates within individual nursing homes to see if patients with Medicaid are treated differently from those with private insurance. 
Said Shubing Cai, Ph.D., lead author of the study and investigator at Brown University: “While we know that nursing homes tend to provide similar quality of care to all residents, hospitalization decisions are often different from the decisions involved in the provision of daily care and have a significant impact on the long-term health of residents.”
While Medicaid and private insurance pay for nursing home-related care, costs associated with hospitalization are covered by Medicare – the federal health insurance program for the elderly. Nursing homes have a strong financial incentive to send sick Medicaid patients to the hospital where the cost will be absorbed by Medicare and the hospital. 
Hospitals and nursing homes are under intense pressure to reduce hospital re-admissions so some of these trends might reverse. But you also have to ask yourself whether or not your loved one is really in the best place for care should they develop something that needs advanced care. All of this as a way of saying keep this in the back of your mind if mom or dad are Medicaid recipients residing in nursing homes.


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