Do hospital-owned skilled nursing facilities provide better post-acute care quality?
As hospitals are increasingly held accountable for patients' post-discharge outcomes under new payment models, hospitals may choose to acquire skilled nursing facilities (SNFs) to better manage these outcomes. This raises the question of whether patients discharged to hospital-based SNFs have better outcomes. In unadjusted comparisons, hospital-based SNF patients have much lower Medicare utilization in the 180 days following discharge relative to freestanding SNF patients. We solved the problem of differential selection into hospital-based and freestanding SNFs by using differential distance from home to the nearest hospital with a SNF relative to the distance from home to the nearest hospital without a SNF as an instrument. We found that hospital-based SNF patients spent roughly 5 more days in the community and 6 fewer days in the SNF in the 180 days following their original hospital discharge with no significant effect on mortality or hospital readmission.
Brown University, Providence, RI 02912, USA. Electronic address: momotazur_rahman@brown.edu.
Momotazur
M
Rahman
University of Michigan, Ann Arbor, MI 48109, USA; NBER, Cambridge, MA 02138, USA.
Edward C
EC
Norton
Harvard Medical School, Boston, MA 02115, USA.
David C
DC
Grabowski
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D010351:Patient Discharge; D010359:Patient Readmission; D012866:Skilled Nursing Facilities / Q000592:standards*; D019467:Subacute Care / Q000592:standards*; D014481:United States
Care utilization trajectory; Hospital-based; Instrumental variable; Medicare; Post-acute care; Skilled nursing facilities
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