Reimbursement Structure

Learning Objectives:

  • Understanding what is included in the cost of care.
  • Being able to define incentive-based (pay for performance) care.
  • Recognizing the impact of Medicaid reimbursement on the quality of care.
  • Explaining the Medicare reimbursement system.
  • Differentiating Quality mix
  • Patient Value


o    An Evaluation of Performance Thresholds in Nursing Home Pay-for-Performance – Werner

o    Explaining state nursing home reimbursement – Harrington

o    How Medicare reimbursement works in skilled nursing facilities – Kander

o    Incremental cost of post acute care in nursing homes – Spector

o    Medicaid Capital Reimbursement Policy – Miller

o    Payer source for single elderly women in nursing homes – Nakagawa

o    The Cost of care – Candrian

o    Impact of Nursing Home Pay for Performance … – Grabowski


These assignments are due  on Thursday July 2nd.

  1. Write a 4 page (100 words) paper describing the overall reimbursement structure in the post acute world. Recognizing that the average SNF in New York loses between $20-$40 per patient per day for a Medicaid patient, include in the paper, an evaluation of the Medicaid reimbursement process and identify how you would overcome the challenge of caring for a population of Medicaid patients and still keep the facility operational.
  2. Write no more than a 1 page (250 words) paper on whether a facility should consider a patient’s payer source when deciding to accept or deny the patient for care.


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