TY - JOUR
T1 - Skilled Nursing Facility Participation in Bundled Payments Was Related to Small Increases in Nurse Staffing Levels
AU - Ying, Meiling
AU - Temkin-Greener, Helena
AU - Thirukumaran, Caroline P.
AU - Joynt Maddox, Karen E.
AU - Holloway, Robert G.
AU - Li, Yue
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2023/3
Y1 - 2023/3
N2 - Medicare implemented Bundled Payments for Care Improvement (BPCI) Model 3 in 2013, in which participating skilled nursing facilities (SNFs) were accountable for episode costs. We performed comparative interrupted time series analyses to evaluate associations between SNF BPCI participation and nurse staffing levels, using Medicare claims, resident assessments, and facility-level and market-level files of 2010–2017. For persistent-participating SNFs, BPCI was associated with improved certified nursing assistant (CNA) staffing levels (differential change =.03 hours, p =.025). However, BPCI was not related to changes in registered nurse (RN) and all licensed nurse hours, and nurse skill mix. Among drop-out SNFs, BPCI was associated with increased RN staffing levels (differential change =.02 hours, p =.009), leading to a higher nurse skill ratio (0.51 percentage points, p =.016) than control SNFs. Bundled payments for care improvement had no impact on CNA and all licensed nurse staffing levels. In conclusion, BPCI was associated with statistically significant but small increases in nurse staffing levels.
AB - Medicare implemented Bundled Payments for Care Improvement (BPCI) Model 3 in 2013, in which participating skilled nursing facilities (SNFs) were accountable for episode costs. We performed comparative interrupted time series analyses to evaluate associations between SNF BPCI participation and nurse staffing levels, using Medicare claims, resident assessments, and facility-level and market-level files of 2010–2017. For persistent-participating SNFs, BPCI was associated with improved certified nursing assistant (CNA) staffing levels (differential change =.03 hours, p =.025). However, BPCI was not related to changes in registered nurse (RN) and all licensed nurse hours, and nurse skill mix. Among drop-out SNFs, BPCI was associated with increased RN staffing levels (differential change =.02 hours, p =.009), leading to a higher nurse skill ratio (0.51 percentage points, p =.016) than control SNFs. Bundled payments for care improvement had no impact on CNA and all licensed nurse staffing levels. In conclusion, BPCI was associated with statistically significant but small increases in nurse staffing levels.
KW - Medicare bundled payments
KW - nurse staffing levels
KW - skilled nursing facility
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U2 - 10.1177/07334648221137060
DO - 10.1177/07334648221137060
M3 - Article
C2 - 36321398
AN - SCOPUS:85141430466
SN - 0733-4648
VL - 42
SP - 456
EP - 463
JO - Journal of Applied Gerontology
JF - Journal of Applied Gerontology
IS - 3
ER -