Discussion: Problem state and research question
Discussion: Problem state and research question
ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS
Post your topic, problem statement, and a minimum of two research questions, based on your problem statement, which will guide your Doctoral Study research. Discussion: Problem state and research question
I need a new problem statement and two research questions. It must be related to the topic ( The effect of Patient-Driven payment model (PDPM) on quality care in nursing homes.
Assignment: Revised Doctoral Study Prospectus
The effect of Patient-Driven payment model (PDPM) on quality care in nursing homes.
Prepared By: Charmaine Maestrado
The world’s population is rapidly aging and the number of elderly people is increasing
daily( Manav, Yeşilot, Demirci,&Öztunç, 2018).1.4 million Americans are living in a nursing
home. Unfortunately, thousands of them are evicted against their wishes simply because of their
eligibility status.It is a troubling trend statewide as the senior population is growing , nursing
home facilities are closing down.The primary contributor of these closures is the low Medicaid
reimbursement rate(s). Majority of the nursing homes are run by large corporate chains that
operate multiple facilities throughout the country.It is illegal to discriminate against residents’
based on payment source. Medicare and Medicaid subsidize different amounts. Medicare pays
more. However , Medicare is not for long term purposes since it will only cover certain days. Discussion: Problem state and research question
Medicare only covers short-term rehabilitation: up to 20 days for 100% after that you have to pay
for the copayment. As of 2017, long term Ombudsman received more than 10,000 complaints
about nursing home discharged and transfers.
Minimizing our costs as a business is always a challenge . Staffing plays a huge part in nursing
home operational costs. If we do not have enough resources to remain in business. We are most
likely going to cut our staff and this is going to impact the care and services we provide to our
patients. The new payment model , the patient-driven payment model (PDPM) is expected to
align reimbursement with shift from volume to value.This study will identify the significant gap
between the funding and the actual cost to providing the care as well as the impact on staffing
levels in the nursing homes.
Purpose of the study
The purpose of this study is to examine the impact of the new payment model on quality of care
in nursing homes. Hettich and Pivec (2018) noted that Under the RUG-IVpayment
system, SNFs are paid at a constant per diem rate, regardless of the length of a resident’s stay,
unless the resident is reclassified into a different group during the stay . It has been three
months since we started the new case-mix model titled the Patient-Driven Payment Model
(PDPM) and replaced the Resourced Utilization Groups or the RUGs model.
Significance of this study
In healthcare, quality is a measure of success. We cannot improve what we cannot measure. The
resident’s health outcome will tell us how we are doing. The study will help us determine how
effective the new model is and identify the impact of it in rehabilitation services and the overall
well being of the resident(s).The goal of Patient-Driven Payment Model is to provide patient-
centered care that treats the resident as a whole instead of reimbursing nursing facilities primarily
for rehabilitation services.The PDPM focuses on clinically relevant factor rather than codes and
other characteristics as the basis for patient classification. It will focus on critical conditions
,patient diagnosis, comorbidity and history of the most recent hospital stays for reimbursement
rates. Rehabilitation services will take a lesser role in reimbursement and PDPM will affect Part
A but not Medicare Advantage patients. Discussion: Problem state and research question
The keywords searched were online doctoral program completion, Elsevier, Emerald insight
and CINAHL Plus.
- Babbie, E. (2017). Briefly discussed the importance of deductive theory and social
- Elliot, A. E., &Barsness, S. (2016). Explained how Medicaid reimbursement started and
importance of staff engagement.
- Hettich, D., &Pivec, A. (2018). Provided information about Prospective payment
system which is under the previous model system. Briefly explained the purpose of Patient-
Driven Payment Model (PDPM).
- Howard,L. (2014). Provided information about the role of the government in reimbursing
skilled nursing facilities.
- Manay,A. Yesilot,S. ,Demirci,P. &Öztunç (2018). Provided information about the
cognitive function and quality of life of elderly people living in a nursing home.
- Moick, S., Simon, J., &Hiesmayr, M. (2019). Nutrition care quality indicators in
hospitals and nursing homes: A systematic literature review and critical appraisal of
current evidence. Clinical Nutrition
I will be using Donabedian Framework and Andersen Behavioural Model. According to the
concept of Donabedian, quality of care is a multidimensional construct. In his framework he
distinguishes between structure, process and outcome indicators that all affect quality of care
(Moick,Simon, &Hiesmayr 2019. I believe this can help me explore both clinical and
leadership aspect in healthcare . Evidence -based practice from previous scholars will be applied.
Under Andersen Model, I can do cost utilization. It can also let me identify important factors
such as measuring quality indicators. We want to be effective and cost-efficient.Since the
payment model just started, it may be too early to distinguish the impact of it but we will see a
combination of extensive services with non therapy ancillary services and with nursing services
to deliver a case mix that finally reimburses the facility for what the services they actually
provide. Our per diem rate should be budget neutral where Rehabilitation therapy will no longer
drives payment. Patient characteristics and MDS coding will drive reimbursement .
RQ–Quantitative: What is the impact of Patient-Driven Payment Model on workforce and
H01- 90% of post acute care are billed to rehabilitation services. The RUGs payment rates are
certainly not dependent on the clinical conditions except for depression as part of the
rehabilitation case-mix. As far as reimbursement , physical therapy (PT) and occupational
therapy (OT) reimbursement rates will decline by 2% every week after the 20th day of stay.
Non-therapy Ancillary services will decline by 66% after the 3rd day of stay. We can be able to
use our pharmacist to help us optimize drug therapy early in a resident’s day instead of having
the pharmacist quarterly for drug regimen review . We can provide admission medication review
to help us identify the barriers and adverse effects, medication errors upon transition and transfer
and to assure that the new admission has a successful stay in our facility while we maximize the
payment rate for them.
Annual federal and state government expenditures for the provision of nursing home care
services through the Medicaid program now exceed US$48 billion. Elderly recipients account for
nearly three-fourths of the total costs of nursing home care, and nursing home care services
comprise 15% of the total Medicaid program spending ( Howard 2014).We are in the crisis
situation. The biggest fear that we might face is that , providers will be forced to close
particularly those facilities in the rural or smaller communities who have a higher percentage
rate of Medicaid.
H1- A study showed that each additional hour of therapy received per week was associated with
a 3.1 percentage point increase in the likelihood a SNF resident was discharged home.
Nature of this study
There is growing tension in long-term care based on an increasing focus on quality of life and
resident experience juxtaposed with reimbursement models shifting to an emphasis on quality of
care and measurable outcomes (Elliot&Barsness, 2016). This will be a quantitative research, we
will focus on data and metrics. Collecting and gathering consistent , valid and measurable data is
necessary in/ for this study. Organizations need to look at their financial planning systems , staff
management practices and ensure that those approaches will align with their business strategies.
The overall purpose of PDPM is to lower costs, improve patient outcomes , augment revenue
sources and optimize the reimbursement that facility is due. I think that PDPM will open new
opportunities for new admission and effective disease management. Discussion: Problem state and research question
Secondary Data Types and Sources of Information
Secondary data will be accessed from an online doctoral program. I will also be using previous
data and studies used by Centers of Medicare and Medicaid to look at factors such as RUGS IV,
PPS model, mix case model and implications of cost analysis for rate setting. The rehabilitation
department will play a significant role in this study.
Long term care organizations need to change their business approaches and strategies because of
the new payment model. The development of PDPM did not take outcomeswhen determining
therapy groups or payment. At this time, it is difficult to determine how the changes will
affect the bottom lines since we just started it. The sources may be also limited since everything
is highly regulated.
Babbie, E. (2017). Basics of social research (7th ed.). Boston, MA: Cengage Learning.
CohenMiller, A. S., & Pate, P. E. (2019). A Model for Developing Interdisciplinary Research
Theoretical Frameworks. Qualitative Report, 24(6), 1211–1226. Retrieved from https://search-ebscohost-
Elliot, A. E., &Barsness, S. (2016). What’s in Your Bundle? Building a Communication Map of
Relational Coordination Practices to Engage Staff in Individualizing Care. Seniors Housing &
Care Journal, 24(1), 3–19. Retrieved from https://search-ebscohost-
Hettich, D., &Pivec, A. (2018). Payment System to Change for Skilled Nursing Facilities:
CMS’s Patient-driven Payment Model revamps PPS for SNFs. (cover story). Dennis Barry’s
Reimbursement Advisor, 34(3), 1–12.
Howard, L. L. 1. larryhoward@fullerton. ed. (2014). Does Government Oversight Improve
Access to Nursing Home Care? Longitudinal Evidence From US Counties. Inquiry (00469580),
51, 1–12. https://doi-org.ezp.waldenulibrary.org/10.1177/0046958014561634
Lo, T. K. T., Parkinson, L., Cunich, M., &Byles, J. (2016). Factors associated with the health
care cost in older Australian women with arthritis: an application of the Andersen’s Behavioural
Model of Health Services Use. Public Health, 134, 64–71.
Manav, A. İ., Yeşilot, S. B., Demirci, P. Y., &Öztunç, G. (2018). An evaluation of cognitive
function, depression, and quality of life of elderly people living in a nursing home. Journal of
Psychiatric Nursing / PsikiyatriHemsireleriDernegi, 9(3), 153–160. https://doi-
Shirey, M. R. (2013). Strategic Leadership for Organizational Change. Lewin’s Theory of
Planned Change as a Strategic Resource. Journal of Nursing Administration, 43(2), 69–72.