Kathryn Hyer, M.P.P., Ph.D., Kali S. Thomas, M.A., Ph.D., Christopher E. Johnson, Ph.D., Jeffrey S. Harman, Ph.D., and Robert Weech-Maldonado, M.B.A., Ph.D.
K. Hyer, K. S. Thomas, C. E. Johnson et al., “Do Medicaid Incentive Payments Boost Quality? Florida’s Direct Care Staffing Adjustment Program,” Journal of Aging and Social Policy, Jan. 2013 25(1):65–82.
States have sought to improve the quality of nursing home care by increasing Medicaid payments for nurse aides, orderlies, and other frontline staff, or by implementing pay-for-performance policies. In this study, Commonwealth Fund–supported researchers evaluate the effects of a Florida incentive program intended to improve care at nursing homes whose low staffing levels and high Medicaid enrollment put them most at risk for providing poor-quality care. Changes in structural, process, and outcomes measures of quality were examined over the 21-month period following the introduction of incentive payments in April 2000.
The findings suggest that "increased Medicaid payments increase staffing, and processes of care follow," write the researchers, who add that "states experimenting with [pay-for-performance] might take note of our findings and tailor ... payments for low-quality providers to changes in structure and process measures, at least for a start-up period." Incentive payments linked solely to outcomes might curtail lower-resourced nursing homes’ ability to improve care quality.