Do Hospital-Owned Skilled Nursing Facilities Provide Better Post-Acute Care Quality?

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

NBER Working Paper No. 22515
Issued in August 2016
NBER Program(s):Aging, Health Care, Health Economics

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.

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Document Object Identifier (DOI): 10.3386/w22515

Published: Momotazur Rahman & Edward C. Norton & David C. Grabowski, 2016. "Do hospital-owned skilled nursing facilities provide better post-acute care quality?," Journal of Health Economics, . citation courtesy of

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