Study suggests, but doesn't prove, negative PPS effect on quality.

Professional staffing levels decreased because of the implementation of the nursing home Prospective Payment System (PPS) and associated rate cuts, but increased under the Balanced Budget Refinement Act of 2000's rate increases, according to a recent report in Health Services Research. Yet the evidence was weak that these staffing changes translated into changes in quality of care, as measured by regulatory compliance, according to the authors. They suggest that "deficiencies may be too inexact a proxy for real changes in quality." Their reservations bolster long-held provider associations' views that the survey process focuses more heavily on check lists than on actual quality of care, even if they weakened the study's conclusions.

To obtain a copy of the report (Konetzka RT, Deokhee Y, Norton EC, Kilpatrick KE. Effects of Medicare payment changes on nursing home staffing and deficiencies. Health Services Research 2004;39:463-88), e-mail [e-mail].

Speaking of PPS rates, the Centers for Medicare & Medicaid Services (CMS) has announced that Medicare funding for SNF care will increase by 2.8%, a move praised by industry provider associations.