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The Effects of Medicare Advantage Contract Concentration on Patients’ Nursing Home Outcomes
Author(s) -
Rahman Momotazur,
Meyers David J.,
Mor Vincent
Publication year - 2018
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 - 10.1111/1475-6773.13073
Subject(s) - minimum data set , medicare advantage , beneficiary , skilled nursing facility , medicine , nursing homes , health plan , family medicine , emergency medicine , nursing , health care , finance , business , economics , economic growth
Objective The Medicare Modernization Act of 2004 allowed Medicare Advantage ( MA ) contracts to form provider networks in order to concentrate their patients among preferred providers. We focus on the skilled nursing facility ( SNF ) industry to assess patients’ health when treating SNF s concentrate more patients from the same MA contract. Data Sources/Study Setting We use Medicare Beneficiary Summary File and Health, HEDIS , and the Minimum Data Set for patient attributes and OSCAR , LTC focus.org, and Nursing Home Compare for SNF attributes. We include 1,069,436 MA enrollees newly admitted to SNF between 2012 and 2014. Study Design Using a MA contract fixed‐effect model, we examine the effect of prevalence of a patient's MA contract in the treating SNF on patient's health outcomes including 180‐day survival, 30‐day hospital readmission, 30‐day home discharge, and nursing home length of stay. We use an Instrumental Variable ( IV ), the expected share of admissions in a SNF from patient's MA contract calculated using a McFadden choice model. Principal Findings We find no relationship between SNF contract concentration and patients’ outcomes after applying the IV . Conclusions While MA plans appear to steer patients to specific SNF s, we do not observe significant returns to patient outcomes related to concentration.