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

2012; Elsevier BV; Volume: 32; Issue: 2 Linguagem: Inglês

10.1016/j.jhealeco.2012.11.008

1879-1646

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

Global Health Care Issues

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.