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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
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
Teams in nursing homes • Interdisciplinary care planning • Mandated by CMS In most facilities • Daily care teams • Prevalence is unknown • Few studies, mostly convenience sample
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.
Study objective: • To examine the cost impact of daily care teams in nursing homes
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
Sample: • 162 free standing nursing homes in New York State with at least 50 beds • 7,418 direct care staff
Data: • Survey of direct care staff • Medicaid cost reports • Case mix data from the NYS DOH
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
*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
Estimated annual variable cost function with probability weights Dependent variable: Log of variable cost N = 135 R2 = 0.97 * Based on robust standard errors.
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.
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
Why are costs increasing at higher penetration levels? • Higher quality? • Pushing teams “too far”? • Different team types? – more specialists