THE EFFECT OF THE RUG-II REIMBURSEMENT SYSTEM UPON THE NURSING HOME INDUSTRY IN NEW YORK STATE.
Contributors: Rensselaer Polytechnic Institute.
Published: 1987
Number of pages: 331
Subjects: Business Administration, Management.; Health Sciences, Public Health.
Description: The effects of the RUG-II System for reimbursing nursing homes for the care provided to Medicaid recipients within New York State was studied. The RUG-II System classifies patients into one of sixteen categories and pays a price to the nursing home for each different category. The effects and impacts of the RUG-II System were discerned through the analysis of a data base comprised of management, cost, quality and case mix intensity data. Data was obtained through a survey of nursing homes completed by 85% of facilities in New York State and retrieval of data from state archives.

Nursing homes responded to the incentives placed in the market by the RUG-II System. Facilities admitted heavier care patients as the average CMI increased by 11%. The number of Rehabilitative Patients increased by 6%. The number of lighter care patients such as the Physical A category decreased by 7%. The average number of quality deficiencies decreased from 4 per facility to 3. Economic performance was improved for the overall industry.

Facilities were categorized into levels of adaptation to the new system. Differences between these categories in the areas of economic performance, management changes, external orientation, possession of goals, and use of Management Information Systems were found. Changes in the management practices employed in facilities in response to the RUG-II System was also identified.

The study demonstrated that Nursing Homes responded to the incentives placed in the market by its designers. It is the first in depth analysis of a Prospective Payment Case Mix Reimbursement System within health care in the United States which uses cost, case mix intensity, management, and quality information. The Prospective Payment Case Mix System is the current policy path being used by the federal government in reimbursement of health care.
Notes: Source: Dissertation Abstracts International, Volume: 49-04, Section: A, page: 0881.

Thesis (PH.D.)--RENSSELAER POLYTECHNIC INSTITUTE, 1987.

School code: 0185.