Table 3.
The Effect of State Case-Mix Payment on Nursing Home Case-Mix Acuity: Facility Fixed-Effects Model Results
| RUG-III NCMI (MDS) | |||
|---|---|---|---|
| Acuity Index (OSCAR) | Admission | Long stay | |
| State policies | |||
| Case-mix payment (1/0) | 0.0133** | 0.0248** | 0.0144** |
| CPI-adjusted Medicaid rate (in 2002 dollars) | 0.0016* | 0.0027** | 0.0044** |
| Percent of Medicaid LTC spending on HCBS | −0.0057** | −0.0022+ | 0.0003 |
| CON for NHs (1/0)† | 0.0083** | — | — |
| Facility characteristics | |||
| For profit (1/0) | −0.0009 | 0.0034 | 0.0016 |
| Chain membership (1/0) | 0.0031 | 0.0055* | 0.0041* |
| Total number of beds | −0.0018** | 0.0021** | −0.0006 |
| Percent of residents paid by Medicare | 0.0023** | 0.0080** | 0.0020** |
| Market (county) characteristics | |||
| Wage index | 0.0085* | 0.0021 | −0.0026 |
| Number of NH beds per 1,000 population 75+ | 0.0000 | −0.0001 | 0.0000 |
| Calendar year‡ | |||
| 1997 | 0.0040** | — | — |
| 1998 | 0.0079** | — | — |
| 1999 | 0.0086** | — | — |
| 2000 | 0.0144** | 0.0090** | 0.0029** |
| 2001 | 0.0188** | 0.0209** | 0.0073** |
| 2002 | 0.0237** | 0.0345** | 0.0130** |
| Intercept | 2.3438** | −0.1112** | −0.3474** |
| R2 (overall) | 0.0015 | 0.1563 | 0.0706 |
| F-test of overall model fit | F(16, 82,457)=26.2 (p > F)=0 | F(12, 41,123)=124.9 (p > F)=0 | F(12, 40,857)=57.2 (p > F)=0 |
RUG-III NCMI, Resource Utilization Group (Version III) based Nursing Case-Mix Index; MDS, Minimum Data Set; OSCAR, On-line Survey Certification and Reporting system; CON, Certificate of Need; NH, nursing home; LTC, long-term care.
†
CON was excluded from the MDS-based model, because there was no change in this variable between 1999 and 2002, and the fixed-effects model only identifies time-varying covariates. Statistical significance
+
p < .10
*
p < .05
**
p < .01.
‡
The base (reference) year is 1996 in the OSCAR-based model and 1999 in the MDS-based model.