Factors Predicting Transitions from Medicare-Only to Medicare-Medicaid Enrollee Status. Nursing Home Entry and Service Utilization


The results in the previous section highlight that a nursing home stay, particularly a non-SNF stay, is strongly predictive of transition to MME status. The analysis indicates that acute care services and SNF use are associated with having a non-SNF nursing home stay (Table 3). For those under 65 with "no prior ER visit resulting in an inpatient admission or SNF care," the rate of entering a non-Medicare-financed nursing home stay is 0.3 per thousand among those under age 65. The corresponding rate among those age 65 and above is 0.5 per thousand. Having an "ER visit resulting in an inpatient admission" leads to a 0.5 per thousand and 0.7 per thousand increase in this rate, respectively. Having a prior "SNF stay" substantially increases the likelihood of having a non-SNF stay, by 5 per thousand for beneficiaries under 65, and 5.5 per thousand for older beneficiaries. Among those under age 65, having both a prior "ER visit resulting in an inpatient admission and SNF stay" within the past six months is associated with an 8.3 per thousand higher rate of entering a non-SNF nursing home. The same pattern of service utilization among those age 65 and above is associated with a 9.4 per thousand increase. These rates likely reflect a significant acute event that requires discharge to a SNF following an inpatient stay.

TABLE 3. Predicted Rates of Nursing Home Entry for Various Pathways, by Age Group
Service Utilization in Past Six Months Age Under 65 Age 65 and Above
from Base2
from Base2
No ER Visit Resulting in Inpatient Stay, or SNF Stay   0.3 --- 0.5 ---
ER Visit Resulting in Inpatient Stay Only 0.7 0.5* 1.1 0.7*
SNF Stay Only 5.3 5.0* 6.0 5.5*
ER Visit Resulting in Inpatient Stay, and SNF Stay 8.6 8.3* 9.9 9.4*
SOURCE: Mathematica analysis of 2008 and 2009 MBSF, CCW Timeline, and Medicare Claims Files.
NOTES: 2,466,398 person-month observations for the under 65 model. 13,992,952 person-month observations for the 65 and above model. Observations are weighted to be representative of the population.
  1. Rates are per 1,000.
  2. Base is no SNF, other Nursing Home, or ER visit resulting in Inpatient stay.

* Statistically different from base rate at the 1% level.

Other predictor variables also are associated with a non-SNF nursing home stay. Each planned inpatient stay increases the odds of entering a nursing home by 33 percent and 23 percent, respectively, for the under 65 and the 65 and above (estimates are found in the Appendix, Table A2). Each outpatient ER visit increases the odds of nursing home entry by 5 percent and 12 percent, respectively. Conversely, the amount of home health care is negatively correlated with nursing home entry (odds ratio=0.98 and 0.96 for the under 65 and the 65 and above, respectively), which is consistent with home health care as a potential substitute for nursing home care.

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