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 2001–2006 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 [2–4]. 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
References
[1]
S. Rosenbaum and J. Teitelbaum, Olmstead at Five: Assessing the Impact, The Kaiser Family Foundation, Washington, DC, USA, 2004.
[2]
R. J. Buchanan, D. Radin, C. Huang, and L. Zhu, “Caregiver perceptions associated with risk of nursing home admission for people with multiple sclerosis,” Disability and Health Journal, vol. 3, no. 2, pp. 117–124, 2010.
[3]
National Multiple Sclerosis Society, Health Care Reform Principles, http://www.nationalmssociety.org/chapters/was/advocacy/health-care-reform/index.aspx, 2008.
[4]
D. E. Northrop and D. Frankel, “Nursing Home Care of Individuals with Multiple Sclerosis,” Guidelines and Recommendations for Quality Care, http://nursing-homes.aplaceformom.com/articles/multiple-sclerosis/, 2011.
[5]
R. J. Buchanan, “The difficulty placing younger medicaid beneficiaries in nursing facilities: commentary,” American Journal of Physical Medicine and Rehabilitation, vol. 72, no. 4, pp. 226–227, 1993.
[6]
R. J. Buchanan, S. Wang, and H. Ju, “Analyses of the minimum data set: comparisons of nursing home residents with multiple sclerosis to other nursing home residents,” Multiple Sclerosis, vol. 8, no. 6, pp. 512–522, 2002.
[7]
R. J. Buchanan and K. P. Lewis, “Services that nursing facilities should provide to residents with MS: a survey of health professionals,” Rehabilitation Nursing, vol. 22, no. 2, pp. 67–72, 1997.
[8]
D. B. Mukamel and W. D. Spector, “Nursing home costs and risk-adjusted outcome measures of quality,” Medical Care, vol. 38, no. 1, pp. 78–89, 2000.
[9]
T. W. Grannemann and R. S. Brown, “Estimating hospital costs: a multiple-output analysis,” Journal of Health Economics, vol. 5, no. 2, pp. 107–127, 1986.
[10]
J. A. Nyman, “Testing for excess demand in nursing home care markets,” Medical Care, vol. 31, no. 8, pp. 680–693, 1993.
[11]
B. E. Fries, D. P. Schneider, W. J. Foley, M. Gavazzi, R. Burke, and E. Cornelius, “Refining a case-mix measure for nursing homes: resource Utilization Groups (RUG-III),” Medical Care, vol. 32, no. 7, pp. 668–685, 1994.
[12]
G. Arling, R. L. Kane, C. Mueller, and T. Lewis, “Explaining direct care resource use of nursing home residents: findings from time studies in four states,” Health Services Research, vol. 42, no. 2, pp. 827–846, 2007.
[13]
Center for Medicare and Medicaid Services, “Cost reports,” https://www.cms.gov/costreports/, 2011.
[14]
Centers for Medicare and Medicaid Services, “Minimal data set data documentation,” CMS, 2008.
[15]
J. N. Morris, C. Hawes, B. E. Fries et al., “Designing the national resident assessment instrument for nursing homes,” Gerontologist, vol. 30, no. 3, pp. 293–307, 1990.
[16]
R. D. Cook and S. Weisberg, Residual and Influence in Regression, Chapman and Hall, New York, NY, USA, 1982.
A. O. Hirschman, “The paternity of an index,” American Economic Review, vol. 54, no. 5, p. 761, 1964.
[19]
Consumer Price Index, Bureau of Labor Statistics, 2011.
[20]
R. J. Buchanan, S. Wang, and H. Ju, “Analyses of the minimum data set: comparisons of nursing home residents with multiple sclerosis to other nursing home residents,” Multiple Sclerosis, vol. 8, no. 6, pp. 512–522, 2002.
[21]
T. A. Coughlin, T. D. McBride, and K. Liu, “Determinants of transitory and permanent nursing home admissions,” Medical Care, vol. 28, no. 7, pp. 616–631, 1990.
[22]
C. W. Noonan, S. J. Kathman, and M. C. White, “Prevalence estimates for MS in the United States and evidence of an increasing trend for women,” Neurology, vol. 58, no. 1, pp. 136–138, 2002.
[23]
G. J. Demakis and R. J. Buchanan, “Rated cognition in nursing home residents with multiple sclerosis: cross-sectional and longitudinal analyses,” Disability and Rehabilitation, vol. 32, no. 17, pp. 1438–1446, 2010.
[24]
J. R. Bowblis, “Market structure, competition from assisted living facilities, and quality of the nursing home industry,” Applied Economic Perspectives and Policy, vol. 34, no. 2, pp. 238–257, 2012.
[25]
R. J. Buchanan, S. Wang, R. A. Martin, and H. Ju, “Utilization of rehabilitation therapies by nursing home residents with MS at admission,” NeuroRehabilitation, vol. 21, no. 3, pp. 223–232, 2006.
[26]
J. Kasper and M. O'Malley, “Nursing home transition programs: perspectives of medicaid care planners,” #7483, 2006.
[27]
W. B. Schwartz, “Looking for a rational way to control costs. Interview by C. Burns Roehrig,” The Internist, vol. 35, no. 8, pp. 16–18, 1994.
[28]
L. Martin, B. E. Fries, J. P. Hirdes, and M. James, “Using the RUG-III classification system for understanding the resource intensity of persons with intellectual disability residing in nursing homes,” Journal of Intellectual Disabilities, vol. 15, no. 2, pp. 131–141, 2011.
