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Study Finds Decreased Hospitalizations, More Efficient Service Use under Capitated Medicaid Program

That was the broad conclusion of a recent comparative study of utilization patterns in the two programs—the first such study to analyze data from both Medicaid and Medicare program files.

The study revealed that both elderly and disabled Medicaid recipients in the Arizona Long-Term Care System (ALTCS), the nation’s first fully capitated Medicaid long-term care program, receive comprehensive evaluation and management services at a rate about 50% higher than those in the New Mexico FFS program (15 versus 10.6 encounters per person-years).

After controlling for eligibility, sociodemographics, and other variables, the investigators found little difference in hospital admission rates between ALTCS enrollees and New Mexico FFS enrollees, with both groups averaging about 0.5 admissions per year. However, ALTCS enrollees averaged 28% fewer days of hospitalization (3.692 versus 4.731) and required about 33% fewer inpatient professional services (e.g., laboratory tests and surgical procedures). With regard to medication use, the study found that ALTCS enrollees typically received more prescriptions than New Mexico Medicaid enrollees (30 versus 26 prescriptions per person-year).

In both states, use of most types of services tended to be lower among the "oldest old" (aged 75 and older) than among those aged 65 to 74.

For a copy of the study report—"Utilization of Services in Arizona’s Capitated Medicaid Program for Long-Term Care Beneficiaries"—write to: Government Printing Office, Superintendent of Documents, P.O. Box 3771954, Pittsburgh, PA 15250-7954.

More States Consider Collaborative Practice Bills

Following the defeat of broad collaborative practice legislation in Colorado last year, state lawmakers are now considering a narrower proposal specific to long-term care. Senate Bill 99-082 would enable pharmacists to play a greater role in provision of drug therapy to hospice and nursing facility residents under signed agreements specifying the scope and limitations of pharmacists’ patient care activities, as well as required documentation procedures. Such agreements also would have to include disclosure of "any financial arrangement" between the physician and pharmacist for the specified activities and a provision for "immediate termination of the agreement by either the physician or the pharmacist."

In Arkansas, the legislature is debating a collaborative practice bill introduced by Rep. Percy Malone, an ASCP member. Under Malone’s proposal, pharmacists entering into collaborative practice protocols would have to possess "a credential certifying that the pharmacist has met the standards of competency established by the board for disease state management or other pharmacy services necessitating a credential," the bill states.

Virginia lawmakers are considering two bills (HB 2428, SB 1154) that would permit pharmacists to assume responsibility for "modification, continuation or discontinuation of drug therapy pursuant to written protocols; the ordering of laboratory tests; or other patient care management measures related to monitoring or improving the outcomes of drug or device therapy" within existing state scope-of-practice parameters.

"In addition to these three states, New York, Pennsylvania, and several others are expected to debate new or pending collaborative practice bills this year," notes ASCP State Affairs Manager Brad Kile. So far, 22 states have enacted some form of collaborative practice legislation or regulations.

David K. Buerger
Senior Editor

Lobby Through www.ASCP.com! To access the latest information on pharmacy and long-term care bills in your state, as well as direct e-mail links to the legislature and governor’s office, visit ASCP’s "State Legislative Map" through the "Government Affairs" main link at www.ASCP.com. The "Government Affairs" page was recently expanded to include a "Legislative Action Center" providing direct e-mail links to members of Congress and talking points to facilitate letter-writing on critical senior care issues.