Elderly nursing home residents with advanced dementia who were enrolled in a Medicare managed care insurance plan were more likely to have do-not-hospitalize orders and less likely to be hospitalized for acute illness than those residents enrolled in traditional Medicare, according to a study from the NYU School of Medicine, and published by JAMA Internal Medicine, a JAMA Network publication.
Researchers compared care and outcomes for nursing home residents with advanced dementia covered by managed care and those covered by traditional fee-for-service (FFS) Medicare. The analysis included 291 residents from 22 nursing homes in the Boston area. Key findings from the study included the following:
- Residents enrolled in managed care were more likely to have do-not-hospitalize orders than those in traditional Medicare (63 percent vs. 51 percent);
- Managed care residents were less likely to be transferred to the hospital for acute illness (4 percent vs. 16 percent);
- Managed care residents had more nursing home-based primary care visits per 90 days (average 5 vs. 4);
- Managed care residents had more nursing home-based nurse practitioner visits (3 vs. 1).
Survival did not differ between groups.
Recent healthcare reform in the United States increases opportunities to improve the quality and cost-effectiveness of care provided to nursing home residents with advanced dementia. Because nursing homes do not receive higher reimbursement to manage acutely ill long-term-care residents on site, nursing homes have had financial incentives to transfer residents to hospitals, according to the study.
Source: JAMA, September 23, 2013
Case Management for Advanced Illness: Best Practices in End-of-Life Care examines Aetna’s Compassionate Care program, a case management approach for this population. The payor’s initiative breaks down barriers commonly encountered in this highly sensitive stage of the health continuum while positively impacting both healthcare utilization and spend.