Periodic Medical Review: The Impact in Pennsylvania

Periodic Medical Review (PMR) of all Medicaid beneficiaries in skilled nursing facilities (SNFs) in Pennsylvania was implemented in fiscal year 1973-74. In this study, the authors explored the impact of PMR through its first four annual review periods. Because over two thirds of all SNF patients who were determined (over the four-year period) to require lower levels of care were identified during the first year of the program, the study was focused on the impact of first-year reviews on patient placements and nursing home industry characteristics in the subsequent years. Although the results did not strongly show that PMR had significant long-term effects, the general conclusions reached were that: 1) first year PMR decisions altered (in the intended direction) SNF patient placements and structural characteristics of the nursing home industry in Pennsylvania; 2) the initial impact of PMR was still apparent by the fourth year, but much weaker; and 3) the PMR review team may have been more lenient in their decisions concerning appropriate levels of care for reviewed SNF patients after the first year.