More than a quarter of long-stay nursing home (NH) residents are hospitalized annually in the US. Bed-hold policies protect residents’ rights to return to their facilities by reserving their beds during brief absences, such as hospitalizations or therapeutic leaves. State Medicaid programs that adopt these policies can reimburse NHs at either the total or a lower percentage of the daily Medicaid rate to reserve beds during resident absences.
Since Medicaid reimbursements often do not cover the cost of providing care in NHs, financial reimbursements owed to bed-hold policies may perversely incentivize NHs to hospitalize residents, as they continue to receive reimbursement while incurring few or no caregiving costs during resident absences. However, recent evidence on the impact of bed-hold policies on resident outcomes is lacking.
To address this gap, Dr. Mark Unruh, associate professor of population health sciences, and colleagues examined the relationship between Medicaid bed-hold policies and the likelihood of hospitalizations and emergency department (ED) visits among long-stay NH residents between 2013 and 2018. Published in JAMA Health Forum, these findings indicate that in 22 states and D.C., there were no significant changes in the likelihood of hospitalization or an ED visit among long-stay NH residents following the adoption of a Medicaid bed-hold policy.
While previous studies found that bed-hold policies were associated with higher rates of hospitalization among residents, these newer findings may be explained by other initiatives aimed at reducing hospital use among NH residents or the implementation of value-based payment initiatives. Given this, the researchers highlight the importance of reevaluating policies over time as the policy environment and organization of health care delivery evolve.
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