Student Spotlight – Michael Cohen

Quality of nursing home care is important to a lot of people — patients, family members, policy makers and health care providers. Alarming stories about understaffing and overmedication of patients with dementia complicates decisions about where to send loved ones upon discharge from a hospital or when deteriorating health makes it unsafe for them to continue living alone. Unfortunately, public policy drivers have not done enough to address this decades-old problem. With maturation of the baby boom generation imminent and pressure from hospitals who need to address their readmission rates, the time is ripe for reassessment, says Michael Cohen, a PhD candidate in the Department of Health Policy and Management.

Fifteen years ago, the modern version of public reporting was adopted to motivate nursing homes to improve quality. Online reviews and easily accessible product information may be effective for optimizing purchases of things like televisions or cars, says Cohen, but it is not clear that nursing home users act like regular consumers. Often a family member has to find a placement in just days after a hospitalization. They may rely on hospital case workers, resort to whichever facility that has an open bed, or default to a local facility for convenience. In many parts of the country, there are no competitors, leaving little incentive for facilities to improve their performance.

Cohen’s research focusses on looking at systemic ways to drive quality improvement. For example, the Affordable Care Act adopted policies to address the revolving door of hospital readmissions in an effort to reduce public spending and improve patient care. If hospitals have excessive readmission rates and don’t show improvement, it could jeopardize their overall Medicare reimbursements. This puts hospitals in a position to help or hurt nursing homes, either by partnering with them to strengthen patient care as patients move back and forth from acute to long-term care, or by selecting preferred institutions to make referrals to.

There may also be possible spillover effects associated with the Medicare Advantage program, a system of managed care plans for senior citizens. Because these health plans receive payments for each patient regardless of how much care they receive, they may be incentivized to keep people healthier through enhanced care management practices. If staff members change their practice styles in response to increasing enrollment in managed care, it may have important implications for long-stay nursing home residents.

Cohen is also studying the effects of a Centers for Medicare and Medicaid program that identifies nursing homes with particularly poor results. Asking questions like: does a more salient reporting system help or make it harder to get better, or how stronger threats to reimbursement would drive better quality, Cohen hopes his work will have very real and broad impact.

In his off hours, Michael found a home with the Yale Curling Club in his first year at Yale. He is now also a member of the Nutmeg Curling Club in Bridgeport and values getting out of the Yale bubble and meeting people from around the state with different backgrounds and occupations.