Shipping out instead of shaping up: Rehospitalization from nursing homes as an unintended effect of public reporting

R. Tamara Konetzka, Daniel Polsky, Rachel M. Werner

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)341-352
Number of pages12
JournalJournal of health economics
Volume32
Issue number2
DOIs
StatePublished - Mar 1 2013
Externally publishedYes

Keywords

  • Information
  • Nursing home care
  • Patient selection
  • Quality
  • Report cards

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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