Abstract
Attractive Medicare payments and new Medicare payment reforms create strong incentives for nursing homes (NHs) to increase their Medicare resident census, but little is known about the possible impact these increases have on quality. While higher Medicare payments might be used for quality improvement, multitasking theory suggests increased attention to one area of care (short-stay care for Medicare patients) can have negative effects on other, unrewarded areas (care for long stay residents). Using data from 2005–2010 (LTCFoucUS.org, Nursing Home Compare, and the Area Health Resources File; approximately 14,500 NHs in each year), we sought to determine whether increased Medicare census was associated with a decrease in quality. Our study found that on average, increased Medicare census in the previous year was associated with modest quality improvement in the next year for a number long-stay care quality indicators. However, this pattern was not universal and preliminary findings suggest it may vary systematically across different types of nursing homes, such as ownership type. Our next phase of analysis will identify which nursing home characteristics are associated with being more likely to maintain or improve quality in response to increased Medicare census, and identify other characteristics associated with being more likely to experience a decline in quality.