1 Does organizing nursing home workforce in teams save costs? Dana B. Mukamel - University of California, Irvine - Center for Health Policy Research Shubing.

Slides:

Advertisements

Similar presentations

Access to Medicare Home Health Care: How Has It Changed Following PPS? Christopher M. Murtaugh Timothy R. Peng Center for Home Care Policy & Research Visiting.

Advertisements

Source: Commonwealth Fund 2006 Health Care Quality Survey. Percent of adults 18–64 with a chronic disease Only One-Third of Patients with Chronic Conditions.

June 2014 ILLINOIS SMALL & RURAL HOSPITALS : Anchors of Their Communities.

Paying for Primary Care: Robert Graham Center Primary Care Forum Washington, DC Two CMS/CMMI payment experiments Jay Crosson March 25, 2014.

Data-Driven Policy Decisions: Uses of Minnesota Hospital Data Julie Sonier Director, Health Economics Program Minnesota Department of Health December 4,

1 Wisconsin Partnership Program Steven J. Landkamer Program Manager Wisconsin Dept. of Health & Family Services July 14, 2004.

Deductible-based Health Insurance Plans: Are Complex Deductible Exemptions Confusing Patients? Mary Reed, DrPH Center for Health Policy Studies, Kaiser.

Results of the 2002 Emergency Pediatric Services and Equipment Supplement (EPSES) to the National Hospital Medical Care Survey (NHAMCS) Centers for Disease.

American Indian and Alaska Native Programs, University of Colorado Denver Costs Associated with Diabetes Treatment and the Diabetes Prevention Demonstration.

American Indian and Alaska Native Programs, University of Colorado Denver Costs Associated with Diabetes Treatment and the Healthy Heart Demonstration.

Analysis of the rationale for, and consequences of, nonprofit and for-profit ownership conversions by Tami Mark Health Services Research, April 1999 Presentation.

© HHL Group March 2013 Ray Wihapi 14 November 2013 Te Whiringa Ora.

Center for Health Workforce Studies December 2010 Health Workforce Planning in New York: Where are We? Where Do We Need to Go? Presentation to the Health.

Physician Acceptance of New Medicaid Patients by State in 2011 Sandra Decker, Ph.D. National Center for Health Statistics NCHS National.

DataBrief: Did you know… DataBrief Series ● October 2012 ● No. 32 Trends in the Residential Care Industry In 2010, 25% of residential care facilities had.

NHP/Brightwood Evaluation If special programs work - clinically and financially - for small groups of members with complex but homogeneous disability and.

THE COMMONWEALTH FUND Exhibit ES-1. Community-Based Strategy for Improving Care of High-Cost Patients Community governance High-cost patients with multiple.

Memorial Hermann Healthcare System Clinical Integration & Disease Management Dan Wolterman April 15, 2010.

Interprofessional Team Rounding: A Value Added Innovative Approach to Align the Educational and Clinical Mission in Health Care Systems Mukta Panda, MD,

Primary Care and Behavioral Health 2/4/2011 CIBHA.

Title text here Health Homes: The 4 th Long-Term Care Policy Summit September 5, 2012 Wendy Fox-Grage AARP Public Policy Institute.

The Influence of Primary Care Practice Climate on Medical Services Costs and Quality of Care Roblin DW 1, Howard DH 2, Becker ER 2, Adams EK 2, Greenfield.

Calculating the Cost of Care Coordination A quick and dirty guide to estimation Deborah Allen, ScD Catalyst Center Boston University School of Public Health.

Workplace Violence Among Nurses: The Minnesota Nurse’s Study Epidemiology Nursing 702 Maria-Idalia O. Lens, RN, PHN, MSN, FNP-C.

National Indian Health Board Annual Consumers Conference September 2014 CMS Tribal Technical Advisory Group Data Project Update Mark LeBeau, PhD Executive.

Component 1: Introduction to Health Care and Public Health in the U.S. 1.1: Unit 1: Introduction to modern healthcare in the US 1.1 a: Introduction and.

Effectiveness of Depression Care Management in a Multiple Disease Care Management Model Bruce Friedman, Ph.D. Departments of Community and Preventive Medicine,

1 Patient Dependence, Function, and Changes in Cost of Care in Alzheimer’s Disease Carolyn W. Zhu JJP VA Medical Center, Mount Sinai School of Medicine.

A Needs Assessment of a Home Health Agency & Education Plan Madjil Clark, BSN, RN, Charity Ebert, BSN, RN, Andrea Englund, BSN, RN & Rita Million, BSN,

1 Minnesota Medical Home Project: Evaluation Feasibility Study Saturday, June 7, 2008 SHRIG Meeting, Academy Health.

Human Capital in the Nursing Workforce and Its Impact on Patient Outcomes Human Capital in the Nursing Workforce and Its Impact on Patient Outcomes Ciaran.

The impact on practice, costs and outcomes of New Roles for health professionals in Europe (MUNROS) Antoinette de Bont/ associate professor/ Erasmus University.

1 10/22/2015 Nursing Home Quality in New York State by Patricia Loubeau Discussion by Kristin J. Kleinjans, University of Aarhus and RAND ZEW Long-Term-Care.

Impact of Restrictive State Policies on Utilization and Expenditures in the Medicaid Program Roberto Vargas, MD, MPH 1,2 Carole Gresenz, PhD 2 Jessie Riposo,

AcademyHealth 2007 Gender Differences in Healthcare Utilization at the End-of Life Andrea Kronman, MD MSc Boston University BIRCWH Faculty Scholar Women’s.

Practice Patterns among Nurse Practitioners in a Transitional Care Pilot for Medicare Advantage and Medicaid Managed Long-term Care Patients Patrick Luib,

Quality of Care for Veterans in Community Nursing Homes Christopher E. Johnson, Ph.D. Associate Professor Department of Health Policy and Management.

Individual Insurance Benefits to be Available under Health Reform Would Have Cut Out-Of-Pocket Spending in Steven C. Hill Center for Financing,

THE URBAN INSTITUTE Examining Long-Term Care Episodes and Care History for Medicare Beneficiaries: A Longitudinal Analysis of Elderly Individuals with.

ALFs and Medicare---DRAFT, NO CITATION OR QUOTATION 1 MEDICARE EXPENDITURES FOR RESIDENTS IN ASSISTED LIVING: DATA FROM A NATIONAL STUDY Phillips C 1,

NCHS July 11, Influenza Immunization in Nursing Homes: Who Does Not Get Immunized and Whose Status is Unknown Jill A. Marsteller, PhD, MPP, Ronald.

THE EFFECT OF MEDICAID RATE ON POTENTIALLY PREVENTABLE HOSPITALIZATIONS FROM NURSING HOME* Orna Intrator with V. Mor, N. Wu, D. Grabowski †, D. Gifford.

1 Does the Supply of Long-term Acute Care Hospitals Matter? Geographic Location and Outcomes of Care for Medicare Ventilator Cases Presented by Kathleen.

ISSUES IN RURAL HEALTH PLANNING WEBINAR 2 THURSDAY, JULY 21, :00 – 2:00 PM UNDERSTAND THE PROS AND CONS OF RURAL HEALTH CLINICS.

The Complete Procedure Coding Book By Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA Chapter 5 Evaluation & Management Codes Part 2 Copyright © 2009 by.

1 The Effect of Primary Health Care Orientation on Chronic Illness Care Management Julie Schmittdiel, Ph.D., Stephen M. Shortell, Ph.D., Thomas Rundall,

Medicare Advantage Payment Extra Payments, Enrollment & Quality of Care Lauren Hersch Nicholas Columbia University AcademyHealth June 3, 2007 Research.

Factors Influencing Nursing Home Response to Quality Measure Publication Jacqueline Zinn, Ph.D. Temple University Dana Mukamel, Ph.D. University of California,

Transition to Reform in Wisconsin Donna McDowell, Director Bureau of Aging & Disability Resources Department of Health Services D. McDowell1.

Reaching Outside the Hospital to Create Community Partnerships Marcia Colone, Ph.D., MS, LCSW, ACM System Director, UCLA Health, Los Angeles, CA Patient.

Robin E. Remsburg, PhD, APRN, BC Beth Han, PhD, MD, MPH National Center for Health Statistics U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for.

THE URBAN INSTITUTE Impacts of Managed Care on SSI Medicaid Beneficiaries: Preliminary Results From A National Study Terri Coughlin Sharon K. Long The.

Managing Care for High-Cost Elderly Duals: A Challenge for Medicaid Michael Birnbaum Director of Policy, Medicaid Institute United Hospital Fund June 2,

The Long-Term Care Workforce Crisis: A 2016 Report.

Medicaid Managed Care for Persons with Severe Mental Illness in New York: Challenges and Implications Michael Birnbaum Director of Policy, Medicaid Institute.

DECEMBER 4, :00 AM TO 12:00 PM (EST) PRESENTATION BY GWEN LAURY RN, CCHC LOUISIANA PRIMARY CARE ASSOCIATION Understanding Louisiana Medical Home.

Development of a Community Stroke Rehabilitation Team “meeting the need” NHS Blackburn with Darwen Tracy Walker Team Leader.

Courage Center Primary Care Clinic: Health Care Home for Persons with Disabilities.

DataBrief: Did you know… DataBrief Series ● September 2011 ● No.18 Differences in Service Utilization by Disability and Residence In 2006, seniors with.

Johns Hopkins Bloomberg School of Public Health Medicare Beneficiaries with Serious Physical or Cognitive Limitations (PCI) Karen Davis Roger C. Lipitz.

Sandra L. Spoelstra, PhD, RN Gerontological Society of America November 16 th, 2012 San Diego, CA Can Nursing Home Transfer Be Delayed If Home and Community-

Disparities in process and outcome measures among adults with persistent asthma David M. Mosen, PhD, MPH; Michael Schatz, MD, MS; Rachel Gold, PhD; Winston.

The Nurse Work Environment and Turnover in Perinatal Hospices

Foster Care Managed Care Program

Community and Primary Care Grants

Multinational Comparisons of Health Systems Data, 2018

Adults with Health Problems Who Have an Excellent Patient Experience Report Greater Support to Help Manage Their Health Condition Percent of adults 18–64.

Maryland HCW Influenza Vaccination Survey Highlights

Adults with Health Problems Who Have an Excellent Patient Experience Are Most Likely to Be Well-Informed About Their Prescription Medications Percent of.

Presentation transcript:

1 Does organizing nursing home workforce in teams save costs? Dana B. Mukamel - University of California, Irvine - Center for Health Policy Research Shubing Cai & Helena Temkin-Greener - University of Rochester School of Medicine - Department of Community & Preventive Medicine Funding: NIA grant # AG23077

2 Team care is viewed as effective Especially for chronic and long-term care Better patient outcomes Lower error rates Better care coordination Better work environment Better staff outcomes

3 Teams in nursing homes Interdisciplinary care planning –Mandated by CMS In most facilities Daily care teams –Prevalence is unknown –Few studies, mostly convenience sample

4 Less is known about the cost implications of teams in nursing homes Physician / nurse practitioner teams were shown to be more cost effective than physicians alone Burl JB, 1991; 1994 & 1998 and Aigner, Specialized wound teams have been shown to be cost effective Vu T, 2007.

5 Study objective: To examine the cost impact of daily care teams in nursing homes

6 Daily care teams defined by the direct care staff in the nursing home as: 1.Formal teams: if staff assigned by management 2.Self-managed teams: if staff self-organized their daily work in teams

7 Sample: 162 free standing nursing homes in New York State with at least 50 beds 7,418 direct care staff

8 Data: Survey of direct care staff Medicaid cost reports Case mix data from the NYS DOH

9 Methods: Hybrid cost function: Weighted regression to account for under response by for profits Inference based on robust standard errors and joint F-tests for highly collinear terms

10 *Information based on the survey question: “Who else is on your team?” 46% of responders report meeting daily 27% of responders report meeting at least weekly

11 Sample (N=135)All NYS study eligible nursing homes (N=531) MeanStandard deviation MeanStandard deviation Percent of direct care staff organized in formal teams n/a Percent of direct care staff in self managed teams n/a Annual variable costs ($1000)20,13517,94917,98816,896 Inpatient days77,071*48,27368,70940,942 Inpatient admissions Average RUG scores n/a Adult day care days2,481*5,0413,53017,125 Number of beds Home health care visits7,96442,5808,28159,039 Outpatient clinics1,0837, ,720 Management hourly wage43.35* CNA hourly wage Non-profit ownership (%)66%*51% * Significant difference at the 0.05 level

12 Independent VariablesCoefficientP Value* Beds0.214 x Case mix adjusted days/1000: Linear Squared x Cubed1.76 x Admissions0.213 x Adult day care days/ Home health care visits/ Outpatient clinic visits/ Log management wages Log CNA wages Non-profit facility Constant N = 135 R2 = 0.97 * Based on robust standard errors. Estimated annual variable cost function with probability weights Dependent variable: Log of variable cost

13 Independent VariablesCoefficientP Value* % direct care staff in formal teams: Linear ** Squared ** Cubed ** % of direct care staff in self managed teams: Linear *** Squared *** Cubed *** ** P value for the hypotheses that the linear, squared and cubed terms are jointly significant is *** P value for the hypotheses that the linear, squared and cubed terms are jointly significant is Estimated annual variable cost function with probability weights Dependent variable: Log of variable cost

14

15 Conclusions: Formal teams are a cost saving strategy The range of cost savings estimated at $174,000 per year Self-managed teams do not seem to have the same impact on cost

16 Why are costs increasing at higher penetration levels? Higher quality? Pushing teams “too far”? Different team types? – more specialists