Volume 51 | Number S1 | February 2016

Abstract List

David C. Grabowski Ph.D., Christopher C. Afendulis, Daryl J. Caudry S.M., A. James O'Malley Ph.D., Peter Kemper,


To evaluate the impact of the Green House () model of nursing home care on Medicare acute hospital, other hospital, skilled nursing facility, and hospice spending and utilization.

Data Sources/Study Setting

Medicare claims and enrollment data from 2005 through 2010 merged with resident‐level minimum data set () assessments.

Study Design

Using a difference‐in‐differences framework, we compared Medicare Part A and hospice expenditures and utilization in 15 nursing homes that adopted the model relative to changes over the same time period in 223 matched nonadopting nursing homes. We applied the same method for residents of homes and for residents of “legacy” homes, the original nursing homes that stay open alongside the home(s).

Principal Findings

The adoption of had no detectable impact on Medicare Part A (plus hospice) spending and utilization across all residents living in the nursing home. When we analyzed residents living in homes and legacy units separately, however, we found that the adoption of the model reduced overall annual Medicare Part A spending by $7,746 per resident, although this appeared to be partially offset by an increase in spending in legacy homes.


To the extent that the model reduces Medicare spending, adopting nursing homes do not receive any of the related Medicare savings under traditional payment mechanisms. New approaches that are currently being developed and piloted, which better align financial incentives for providers and payers, could incentivize greater adoption of the model.