Medicare and Medicaid dual-eligible beneficiaries use more medical care and experience worse health outcomes than Medicare-only beneficiaries. This article points to a possible inefficiency in the skilled nursing facility (SNF) admission process, specifically that patients and SNFs are partially matched based on dual-eligibility status, and investigates its influence on patients' SNF length of stay. Using a set of fee-for-service beneficiaries newly admitted for Medicare-paid SNF care, we document two findings: (1) compared with Medicare-only patients, dual-eligibles are more likely to be discharged to SNFs with low nurse-to-patient ratios and (2) dual-eligibles are more likely to become long-stay nursing home residents than Medicare-only beneficiaries if treated in SNFs with low nurse-to-patient ratios. We conclude that changes in the current SNF care referral process have the potential to reduce excess SNF utilization by dual-eligible beneficiaries and could help reduce spending by both Medicare and Medicaid.
Dual eligibility, selection of skilled nursing facility, and length of Medicare paid postacute stay
Rahman, M., Gozalo, P., Tyler, D., Grabowski, D. C., Trivedi, A., & Mor, V. (2014). Dual eligibility, selection of skilled nursing facility, and length of Medicare paid postacute stay. Medical Care Research and Review, 71(4), 384-401. https://doi.org/10.1177/1077558714533824