Skilled nursing facilities

Wednesday, June 15, 2016: 12:00 PM-1:30 PM
419 (Fisher-Bennett Hall)
Peter J. Huckfeldt

Each year, Medicare covers 2.4 million stays in skilled nursing facilities (SNFs) for Medicare fee-for-service beneficiaries requiring nursing or rehabilitation services after being discharged from the hospital, leading to $28.8 billion in spending. However, concerns have been raised that the care provided in SNFs is based on maximizing payment rather than clinical necessity, that there are deficiencies in quality of care in SNFs, and that there is insufficient coordination of care between SNFs and other providers (such as hospitals). This session studies three questions related to Medicare SNF care. One approach for improving the quality of SNF care has been the publicly reporting of quality. The first paper in this session examines whether observed quality improvements represent true improvements in quality or manipulation of reporting systems by nursing homes. Some hospitals have either developed narrow networks of “preferred” SNFs that demonstrate lower resource use and higher quality or acquired SNFs to better manage processes of care. The second paper in this session examines historical differences in preferred and non-preferred SNFs in health care systems with narrow networks and simulates potential changes in overall quality of care and Medicare spending from shifting volume to preferred SNFs. The third paper in this session investigates whether hospital-based SNFs exhibit lower Medicare utilization than freestanding SNFs.

12:00 PM
Nursing home expenditures and improvement in reported quality scores

Author(s): Hari Sharma

Discussant: Marcelo Coca Perraillon

12:20 PM
Quality and costs in narrow network skilled nursing facilities

Author(s): Neeraj Sood

Discussant: Andrew Wilcock

12:40 PM
Do Hospital-Based Skilled Nursing Facilities Provide Better Post-Acute Care Discharge Outcomes?

Author(s): David C. Grabowski; Momotazur Rahman; Edward C. Norton

Discussant: Guy David