title: Shipping out instead of shaping up: rehospitalization from nursing homes as an unintended effect of public reporting.
abstract: Public reporting of health care quality has become a popular tool for incenting quality improvement. A fundamental question about public reporting is whether it causes providers to select healthier patients for treatment. In the nursing home post-acute setting, where patients must achieve a minimum length of stay to be included in quality measures, selection may take the form of discharge from the nursing home using rehospitalization, a particularly costly and undesirable outcome. We study the population of post-acute patients of skilled nursing facilities nationwide during 1999-2005 to assess whether selective rehospitalization occurred when public reporting was instituted in 2002, using multiple quasi-experimental designs to identify effects. We find that after public reporting was implemented, rehospitalizations before the length-of-stay cutoff increased. We conclude that nursing homes rehospitalize higher-risk post-acute patients to improve scores, providing evidence for selection behavior on the part of nursing home providers in the presence of public reporting.
authors: University of Chicago, 5841 S. Maryland, MC2007, Chicago, IL 60637, USA. konetzka@uchicago.edu
authors: R Tamara
authors: RT
authors: Konetzka
authors: Daniel
authors: D
authors: Polsky
authors: Rachel M
authors: RM
authors: Werner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D030881:Disclosure; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D018579:Patient Selection; D019984:Quality Indicators, Health Care; D014481:United States