Since June 2000, David Gifford, M.D., M.P.H., and his colleagues at Brown University, have been evaluating the effect of the Medicare Prospective Payment System (PPS) for skilled nursing facilities (SNF) through a HCFO-funded grant.

The researchers are examining the effect of the SNF PPS on both facility-level indicators (e.g., case-mix, changes in SNFs, and bed availability) and on patient-level indicators (e.g., access to SNFs, utilization of costly care, and rehospitalization) during high acuity episodes. Preliminary results show that SNF PPS has not adversely affected most nursing home residents and that fewer patients are being discharged to freestanding nursing facilities and more are being discharged to other settings (e.g., home, assisted living, or acute rehabilitation centers), or are dying in the hospital. For a full description of Gifford’s findings, please see HCFO’s latest Findings Brief, “New Payment System Has Little Effect on Access and Quality.”

“Overall, there does not appear to be any impact on access to nursing home care following PPS, mainly because the number of patients who are expensive for nursing homes under PPS are small in number," says Gifford. "Our data seem to support anecdotal stories about access problems but show that, although these stories are valid in themselves, they are just that: anecdotal." Gifford acknowledges, however, that the cumulative impact of PPS and Medicaid reimbursements could lead to access and quality problems.

Gifford’s career activities generally revolve around his professional passion: evaluating and improving quality of care, particularly in long-term care settings. In addition to being assistant professor of medicine and community health and a member of the Center for Gerontology and Health Services Research at Brown University, Gifford (known as “Giff” to friends and colleagues) also serves as chief medical officer for Quality Partners of Rhode Island. Qualty Partners is the RI Quality Improvement Organization (QIO). Gifford directs the hospital and nursing home quality-based improvement projects in RI, as well as providing support to all the QIOs working in the nursing home setting.

“Working at the QIO allows me to translate research findings into practice,” Gifford says, “Also, as the lead QIO supporting CMS’s Nursing Home Quality Initiative, we are able to affect quality in nursing homes on a national level.”

Gifford completed his primary care residency and geriatric fellowship at UCLA after graduating from Case Western Reserve University. He also received his M.P.H. in epidemiology from UCLA while he was a Robert Wood Johnson Foundation Clinical Scholar. When asked what the next several months will bring, Gifford says, “We will continue to finalize manuscripts of our findings from this project, along with developing material and approaches to assist nursing homes in improving their quality of care despite their financial and staffing difficulties.”

Journal Articles

Angelelli, J. et al. “Access to Postacute Nursing Home Care Before and After BBA,” Health Affairs, Vol. 21, No. 5, Sept/Oct 2002, pp. 254-264.

Angelelli, J. et al. “An Analysis of Postacute Treatment and Outcome Differences Between Medicare Fee-for-Service and Managed Care,” The Gerontologist, in press.