Improvements in independence in activities of daily living could reflect strategic downcoding rather than real health improvements<\/p>\n<\/h3>\n
By Elana Gotkine HealthDay Reporter<\/b>
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THURSDAY, Jan. 22, 2026 (HealthDay News) — A Medicaid policy that incentivizes high staffing levels in nursing homes is associated with modest improvement in patient health, according to a study published online Jan. 16 in JAMA Health Forum<\/em>.<\/p>\n Andrew Olenski, Ph.D., from Lehigh University in Bethlehem, Pennsylvania, and colleagues examined the impact of policies to raise staffing through payment reforms and staffing regulations on patient health by studying a recent Illinois payment reform aimed at increasing staffing at Medicaid-serving facilities. By providing facilities with bonus Medicaid reimbursements up to $38.68 per Medicaid resident-day based on acuity-adjusted staffing levels, the policy incentivized greater staffing. Two difference-in-differences models comparing changes in health outcomes before and after the reform were estimated against distinct control groups: high-Medicaid facilities in other states and low-Medicaid facilities in Illinois.<\/p>\n The researchers found that both analyses provided some evidence that patient health was improved with the induced staffing increases. The 90-day hospitalization rates decreased by 0.51 percent for patients in Illinois relative to patients in other states after the reform, representing a reduction of about 4.1 percent of the mean. The estimates within states were broadly similar. Substantial improvements in independence in activities of daily living (ADL) were found in both analyses; however, these reductions could reflect strategic downcoding rather than real health improvements since bonus payments were based on acuity-adjusted staffing levels, allowing facilities to increase their payments by reporting residents as low acuity and requiring little ADL-related care.<\/p>\n “The financial incentive structure in this setting prevents us from distinguishing whether improvements to ADLs and other financially tied factors are truly health improvements rather than downcoding,” the authors write.<\/p>\n