%0 Journal Article
%T Is There Extra Cost of Institutional Care for MS Patients?
%A Katia Noyes
%A Alina Bajorska
%A Bianca Weinstock-Guttman
%A Dana B. Mukamel
%J Multiple Sclerosis International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/713627
%X Throughout life, patients with multiple sclerosis (MS) require increasing levels of support, rehabilitative services, and eventual skilled nursing facility (SNF) care. There are concerns that access to SNF care for MS patients is limited because of perceived higher costs of their care. This study compares costs of caring for an MS patient versus those of a typical SNF patient. We merged SNF cost report data with the 2001¨C2006 Nursing Home Minimum Data Set (MDS) to calculate percentage of MS residents-days and facility case-mix indices (CMIs). We estimated the average facility daily cost using hybrid cost functions, adjusted for facility ownership, average facility wages, CMI-adjusted number of SNF days, and percentage of MS residents-days. We describe specific characteristics of SNF with high and low MS volumes and examine any sources of variation in cost. MS patients were no longer more costly than typical SNF patients. A greater proportion of MS patients had no significant effect on facility daily costs ( ). MS patients were more likely to receive care in government-owned facilities (OR = 1.904) located in the Western (OR = 2.133) and Midwestern (OR = 1.3) parts of the USA ( ). Cost of SNF care is not a likely explanation for the perceived access barriers that MS patients face. 1. Introduction Multiple sclerosis (MS) affects younger adults and leads to permanent disability. As a result of MS progression and relapses, many MS patients require increasing levels of medical and supportive services and eventually may need long-term skilled nursing facility (SNF) care. Since 1999, the United States Supreme Court¡¯s decision of Olmstead v. L.C., a ruling that requires states to eliminate unnecessary segregation of persons with disabilities and to ensure that persons with disabilities receive services in the most integrated setting appropriate to their needs, has shifted the landscape of services for individuals with disability [1]. Earlier reports by MS patient organizations, care-givers groups, and policy advocates expressed concerns that SNFs and long-term care insurance plans may perceive cost of care for an individual with MS higher than the costs of caring for a typical (elderly and frail) SNF resident, and, hence, they may selectively encourage MS patients with skilled nursing care needs to leave their facility or deny admission [2¨C4]. Research suggests several potential reasons for this ¡°cream-skimming¡± behavior that may lead to difficulties for MS patients getting the skilled nursing care they need. These factors include younger age of MS patients
%U http://www.hindawi.com/journals/msi/2013/713627/