Hospital provision of institutional long-term care: pattern and correlates

Inpatient Rehabilitation Facilities

When Medicare implemented a prospective payment system (PPS) for inpatient rehabilitation facilities (IRFs) in 2002, a lack of organizational research on IRFs hampered the ability to predict how providers would modify their behavior in response to the PPS. This study consists of 36 key informant interviews that examined the experiences of nine IRFs in the lead-up to and aftermath of the IRF-PPS. Drawing on earlier work by Oliver, the authors develop a taxonomy of the new organizational practices that IRFs adopted in response to the changing payment system. A model of key organizational and environmental characteristics that predict the adoption of these practices based on an IRF’s willingness and/or capacity to comply with institutional pressure is then proposed. The proposed model can also be applied to other regulatory changes affecting IRFs.

The primary care physician's role in nursing facility care

As more care is shifted from the acute care hospital and other sites to nursing facilities, and as the complexity of nursing facility care increases, more is expected of attending physicians. Physicians play an important role in helping patients and their families in this setting and in working with the facility staff in caring for these patients. Structuring visits to address patient and family needs and staff concerns; reviewing resident assessment instruments, care plans, and orders for care; and carefully documenting and coding those visits in such a way as to represent the purpose and complexity of the visit and the patient's clinical circumstances not only helps to improve the overall care provided to the patient but also helps others such as payors and regulators who are concerned about quality of care to have a better understanding of the patient's situation and future plans and expectations. Thus, as nursing facility care becomes more complex, the role of physicians in the nursing facility becomes even more essential.

Innovation in nursing homes: which facilities are the early adopters?

PURPOSE

This study examined organizational and market factors associated with nursing homes that are most likely to be early adopters of innovations. Early adopter institutions, defined as the first 20% of facilities to adopt an innovation, are important because they subsequently facilitate the diffusion of innovations to others in the industry.

DESIGN AND METHODS

Two groups of innovations were examined, special care units and subacute care services. I used discrete-time logistic regression analysis and nationally representative data from 13,162 facilities at risk of being early adopters of innovations during twelve 6-month intervals from 1992 to 1997.

RESULTS

Organizational factors that increase the likelihood of early innovation adoption are larger bed size, chain membership, and high levels of private-pay residents. Four market factors that increase the likelihood of early innovation adoption are: a retrospective Medicaid reimbursement methodology, a more competitive environment, higher average income in the county, and a higher number of hospital beds in the county.

IMPLICATIONS

This analysis shows that organizational and market characteristics of nursing homes affect their propensity toward early adoption of innovations. Some of the results may be useful for nursing home administrators and policy makers attempting to promote innovation.