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The Impact of Hospital‐Based Skilled Nursing Facility Closures on Rehospitalizations
Author(s) -
Rahman Momotazur,
Zinn Jacqueline S.,
Mor Vincent
Publication year - 2013
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12001
Subject(s) - zip code , medicine , prospective payment system , emergency medicine , payment , skilled nursing facility , geography , business , finance , cartography
Objective To examine the effect of reductions in h ospital‐ b ased ( HB ) s killed n ursing f acility ( SNF ) bed supply on the rate of rehospitalization of patients discharged to any SNF from zip codes that lost HB beds. Data Source We used M edicare enrollment records, M edicare hospital and SNF claims, and nursing home M inimum D ataset assessments and characteristics ( OSCAR ) to examine nearly 10 million M edicare fee‐for‐service hospital discharges to SNF s between 1999 and 2006. Study Design We calculated the number of HB and freestanding ( FS ) SNF beds within a 22 km radius from the centroid of all zip codes in which M edicare b eneficiaries reside in all years. We examined the relationship between HB and FS bed supply and the rehospitalization rates of the patients residing in corresponding zip codes in different years using zip code fixed effects and instrumental variable methods including extensive sensitivity analyses. Principal Findings Our estimated coefficients suggest that closure of 882 HB homes during our study period resulted in 12,000–18,000 extra rehospitalizations within 30 days of discharge. The effect was largely concentrated among the most acutely ill, high‐need patients. Conclusions SNF patient‐based prospective payment resulted in closure of higher cost HB facilities that had served most postacute patients. As other, less experienced SNF s replaced HB facilities, they were less able to manage high acuity patients without rehospitalizing them.