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Cost-Saving Strategies of Nursing Home Workforce Teams

This study explores the financial impact of organizing nursing home staff into teams, revealing that formal teams lead to significant cost savings. Research suggests that interdisciplinary team care in nursing homes enhances patient outcomes, reduces errors, and improves staff well-being. The study delves into the specific cost implications of daily care teams with insights from direct care staff and comprehensive data analysis. Findings indicate that formal teams are effective in reducing costs, with estimated annual savings of up to $174,000. However, self-managed teams may not yield the same financial benefits. The study also raises questions about the factors contributing to cost increases at higher team penetration levels.

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Cost-Saving Strategies of Nursing Home Workforce Teams

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  1. Does organizing nursing home workforce in teams save costs? Dana B. Mukamel- University of California, Irvine - Center for Health Policy Research Shubing Cai & Helena Temkin-Greener -University of Rochester School of Medicine - Department of Community & Preventive Medicine Funding: NIA grant # AG23077

  2. Team care is viewed as effective • Especially for chronic and long-term care • Better patient outcomes • Lower error rates • Better care coordination • Better work environment • Better staff outcomes

  3. Teams in nursing homes • Interdisciplinary care planning • Mandated by CMS In most facilities • Daily care teams • Prevalence is unknown • Few studies, mostly convenience sample

  4. Less is known about the cost implications of teams in nursing homes • Physician / nurse practitioner teams were shown to be more cost effective than physicians alone Burl JB, 1991; 1994 & 1998 and Aigner, 2004. • Specialized wound teams have been shown to be cost effective Vu T, 2007.

  5. Study objective: • To examine the cost impact of daily care teams in nursing homes

  6. Daily care teams defined by the direct care staff in the nursing home as: Formal teams: if staff assigned by management Self-managed teams: if staff self-organized their daily work in teams

  7. Sample: • 162 free standing nursing homes in New York State with at least 50 beds • 7,418 direct care staff

  8. Data: • Survey of direct care staff • Medicaid cost reports • Case mix data from the NYS DOH

  9. Methods: Hybrid cost function: • Weighted regression to account for under response by for profits • Inference based on robust standard errors and joint F-tests for highly collinear terms

  10. *Information based on the survey question: “Who else is on your team?”46% of responders report meeting daily27% of responders report meeting at least weekly

  11. * Significant difference at the 0.05 level

  12. Estimated annual variable cost function with probability weights Dependent variable: Log of variable cost N = 135 R2 = 0.97 * Based on robust standard errors.

  13. Estimated annual variable cost function with probability weights Dependent variable: Log of variable cost ** P value for the hypotheses that the linear, squared and cubed terms are jointly significant is 0.004. *** P value for the hypotheses that the linear, squared and cubed terms are jointly significant is 0.426.

  14. Conclusions: • Formal teams are a cost saving strategy • The range of cost savings estimated at $174,000 per year • Self-managed teams do not seem to have the same impact on cost

  15. Why are costs increasing at higher penetration levels? • Higher quality? • Pushing teams “too far”? • Different team types? – more specialists

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