The majority of nursing home care is paid for by Medicaid and private payers. Medicare pays for a specific type of nursing home care, called skilled nursing care, through Medicare Part A. This care constitutes 25 percent of all nursing home care.

  • Clinical quality: The Minimum Data Set evaluates care in nursing homes. There are only three measures in this set that pertain to skilled nursing facilities. Evaluation of nursing homes is available through the Medicare Nursing Home Compare website.

  • Patient-centeredness: A Nursing Home CAHPS survey is still being developed to assess both patient and family experiences of care. Field testing was completed in January 2006; the final approval date for the instrument has yet to be determined.

  • Efficiency: See the section on hospital care for one possible method.

Timing of Pay for Performance

As described in Chapter 5, measures are not yet available that can adequately characterize care provided by skilled nursing facilities. Until such measures are developed, pay for performance should not be implemented in this setting. Once the necessary measures were available, implementation would proceed in a fashion similar to that for the other settings where pay for public reporting would precede pay for performance.

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