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.
We would like to thank Christian Brostrup-Jensen and other members of CGHCR for helping us with data retrieval. We are grateful for comments by Guy David and to seminar participants at the London School of Economics, ASHEcon, CIRANO (Montreal), Tulane University and Texas A&M University. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
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