{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T03:29:52Z","timestamp":1791602992016,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,12,19]],"date-time":"2013-12-19T00:00:00Z","timestamp":1387411200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Dual eligibles, persons who qualify for both Medicare and Medicaid coverage, often receive poorer quality care relative to other Medicare beneficiaries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine whether dual eligibles are discharged to lower quality post\u2010acute skilled nursing facilities (<jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content>s) compared with Medicare\u2010only beneficiaries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Research Design<\/jats:title><jats:p>Following the random utility maximization model, we specified a discharge function using a conditional logit model and tested how this discharge rule varied by dual\u2010eligibility status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects<\/jats:title><jats:p>A total of 692,875 Medicare fee\u2010for\u2010service patients (22% duals) who were discharged for Medicare paid <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content> care between July 2004 and June 2005.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measures<\/jats:title><jats:p>Medicare enrollment and the Medicaid Analytic Extract files were used to determine dual eligibility. The proportion of Medicaid patients and nursing staff characteristics provided measures of <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content> quality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Duals are more likely to be discharged to <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content>s with a higher share of Medicaid patients and fewer nurses. These results are robust to estimation with an alternative subsample of patients based on primary diagnoses, propensity of being dual eligible, and likelihood of remaining in the nursing home.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Disparities exist in access to quality <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content> care for duals. Strategies to improve discharge planning processes are required to redirect patients to higher quality providers, regardless of Medicaid eligibility.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.12142","type":"journal-article","created":{"date-parts":[[2013,12,19]],"date-time":"2013-12-19T12:23:25Z","timestamp":1387455805000},"page":"798-817","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Are Dual Eligibles Admitted to Poorer Quality Skilled Nursing Facilities?"],"prefix":"10.1111","volume":"49","author":[{"given":"Momotazur","family":"Rahman","sequence":"first","affiliation":[{"name":"Department of Health Services Policy and Practice Brown University Providence RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Grabowski","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy Harvard Medical School Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro L.","family":"Gozalo","sequence":"additional","affiliation":[{"name":"Department of Health Services Policy and Practice Brown University Providence RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kali S.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Health Services Policy and Practice Brown University Providence RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Mor","sequence":"additional","affiliation":[{"name":"Department of Health Services Policy and Practice Brown University Providence RI"},{"name":"Providence Veterans Administration Medical Center Health Services Research Program Providence RI"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,12,19]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"AHCA.2013.Uncompensated Care Medicare Bad Debt Coverage to Skilled Nursing Facility: A Critical Lifeline[accessed on March 20 2013]. 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