Medicare Usage Changes in Nursing Homes and Their Impacts on Long-Stay Resident Outcomes.

Medicare provides skilled nursing facility (SNF) coverage for short-stay rehabilitation in nursing homes (NHs) at a better rate than Medicaid covers long-term NH care. National trends of increasing Medicare days culminated in 2010/2011 with a reduction to the SNF rates. Before the cuts, NHs that increased SNF days also improved outcomes for long-stay residents, including pain, pressure ulcer, and functional decline outcomes, suggesting spillover effects of SNF days. We replicated the prior study to determine how changes in SNF days and long-stay outcomes related following the rate cut. From 2011 to 2014, SNF days decreased and all three study outcomes improved. Spillover effects were not consistently observed. Decreasing SNF days was associated with increasing percentages of long-stay residents with daily pain and with decreasing percentages of long-stay residents getting pressure ulcers. Research on these associations in more recent years is needed to determine whether they persist and to inform practice.