Shipping Out Instead of Shaping Up: Rehospitalization from Nursing Homes as an Unintended Effect of Public Reporting

34 Pages Posted: 6 Apr 2012

See all articles by R. Tamara Konetzka

R. Tamara Konetzka

University of Chicago

Daniel Polsky

Bloomberg School of Public Health, Department of Health Policy and Management, Johns Hopkins University; Johns Hopkins University - Carey Business School

Rachel M. Werner

University of Pennsylvania - Perelman School of Medicine

Date Written: February 24, 2012

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.

Keywords: Report cards, Quality, Information, Nursing home care, Patient selection

JEL Classification: L15, I11, I18

Suggested Citation

Konetzka, R. Tamara and Polsky, Daniel and Werner, Rachel, Shipping Out Instead of Shaping Up: Rehospitalization from Nursing Homes as an Unintended Effect of Public Reporting (February 24, 2012). Available at SSRN: https://ssrn.com/abstract=2034967 or http://dx.doi.org/10.2139/ssrn.2034967

R. Tamara Konetzka (Contact Author)

University of Chicago ( email )

1101 East 58th Street
Chicago, IL 60637
United States

Daniel Polsky

Bloomberg School of Public Health, Department of Health Policy and Management, Johns Hopkins University ( email )

624 North Broadway
Baltimore, MD 21205
United States

Johns Hopkins University - Carey Business School ( email )

100 International Drive
Baltimore, MD 21202
United States

Rachel Werner

University of Pennsylvania - Perelman School of Medicine ( email )

423 Guardian Drive
Philadelphia, PA 19104
United States

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