Shipping Out Instead of Shaping Up: Rehospitalization from Nursing Homes as an Unintended Effect of Public Reporting
34 Pages Posted: 6 Apr 2012
Date Written: February 24, 2012
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.
Keywords: Report cards, Quality, Information, Nursing home care, Patient selection
JEL Classification: L15, I11, I18
Suggested Citation: Suggested Citation