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Do hospital-owned skilled nursing facilities provide better post-acute care quality?

Author

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  • Rahman, Momotazur
  • Norton, Edward C.
  • Grabowski, David C.
Abstract
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.

Suggested Citation

  • Rahman, Momotazur & Norton, Edward C. & Grabowski, David C., 2016. "Do hospital-owned skilled nursing facilities provide better post-acute care quality?," Journal of Health Economics, Elsevier, vol. 50(C), pages 36-46.
    • Handle: RePEc:eee:jhecon:v:50:y:2016:i:c:p:36-46
    DOI: 10.1016/j.jhealeco.2016.08.004
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    1. David C. Grabowski & Edward C. Norton, 2012. "Nursing Home Quality of Care," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 29, Edward Elgar Publishing.
    2. Norton, Edward C., 2000. "Long-term care," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 17, pages 955-994, Elsevier.
    3. Andrew M. Jones (ed.), 2012. "The Elgar Companion to Health Economics, Second Edition," Books, Edward Elgar Publishing, number 14021.
    4. David C. Grabowski & Jonathan Gruber & Joseph J. Angelelli, 2008. "Nursing Home Quality as a Common Good," The Review of Economics and Statistics, MIT Press, vol. 90(4), pages 754-764, November.
    5. Grabowski, David C. & Feng, Zhanlian & Hirth, Richard & Rahman, Momotazur & Mor, Vincent, 2013. "Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 32(1), pages 12-21.
    6. Guy David & Evan Rawley & Daniel Polsky, 2013. "Integration and Task Allocation: Evidence from Patient Care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 22(3), pages 617-639, September.
    7. Joseph J. Doyle, 2011. "Returns to Local-Area Health Care Spending: Evidence from Health Shocks to Patients Far from Home," American Economic Journal: Applied Economics, American Economic Association, vol. 3(3), pages 221-243, July.
    8. Rahman, Momotazur & Foster, Andrew D., 2015. "Racial segregation and quality of care disparity in US nursing homes," Journal of Health Economics, Elsevier, vol. 39(C), pages 1-16.
    9. Grabowski, David C. & Afendulis, Christopher C. & McGuire, Thomas G., 2011. "Medicare prospective payment and the volume and intensity of skilled nursing facility services," Journal of Health Economics, Elsevier, vol. 30(4), pages 675-684, July.
    10. A. J. Culyer & J. P. Newhouse (ed.), 2000. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, edition 1, volume 1, number 1.
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    Citations

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    Cited by:

    1. Konetzka, R. Tamara & Stuart, Elizabeth A. & Werner, Rachel M., 2018. "The effect of integration of hospitals and post-acute care providers on Medicare payment and patient outcomes," Journal of Health Economics, Elsevier, vol. 61(C), pages 244-258.
    2. Atul Gupta & Sabrina T Howell & Constantine Yannelis & Abhinav Gupta, 2024. "Owner Incentives and Performance in Healthcare: Private Equity Investment in Nursing Homes," The Review of Financial Studies, Society for Financial Studies, vol. 37(4), pages 1029-1077.
    3. Templeton, Zachary S. & Apathy, Nate C. & Konetzka, R. Tamara & Skira, Meghan M. & Werner, Rachel M., 2023. "The health effects of nursing home specialization in post-acute care," Journal of Health Economics, Elsevier, vol. 92(C).
    4. Thomas Rapp & Jonathan Sicsic & Neda Tavassoli & Yves Rolland, 2023. "Do not PIMP my nursing home ride! The impact of Potentially Inappropriate Medications Prescribing on residents’ emergency care use," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(7), pages 1085-1100, September.
    5. R. Tamara Konetzka & Fan Yang & Rachel M. Werner, 2019. "Use of instrumental variables for endogenous treatment at the provider level," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 710-716, May.
    6. Julien Forder & Katerina Gousia & Eirini-Christina Saloniki, 2019. "The impact of long-term care on primary care doctor consultations for people over 75 years," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 375-387, April.
    7. Sean Shenghsiu Huang & John R. Bowblis, 2018. "The principal–agent problem and owner‐managers: An instrumental variables application to nursing home quality," Health Economics, John Wiley & Sons, Ltd., vol. 27(11), pages 1653-1669, November.
    8. Sean Shenghsiu Huang & John R. Bowblis, 2019. "Private equity ownership and nursing home quality: an instrumental variables approach," International Journal of Health Economics and Management, Springer, vol. 19(3), pages 273-299, December.
    9. Cornell, Portia Y. & Grabowski, David C. & Norton, Edward C. & Rahman, Momotazur, 2019. "Do report cards predict future quality? The case of skilled nursing facilities," Journal of Health Economics, Elsevier, vol. 66(C), pages 208-221.
    10. Julien Forder & Florin Vadean & Stacey Rand & Juliette Malley, 2018. "The impact of long‐term care on quality of life," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 43-58, March.
    11. Kuhlmey, Florian & Minke, Matthias, 2018. "Estimating Survival Times Using Swiss Hospital Data," Working papers 2018/14, Faculty of Business and Economics - University of Basel.

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    More about this item

    Keywords

    Hospital-based; Skilled nursing facilities; Medicare; Care utilization trajectory; Instrumental variable; Post-acute care;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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