Working Paper: NBER ID: w22515
Authors: Momotazur Rahman; Edward C. Norton; David C. Grabowski
Abstract: As hospitals are increasingly held accountable for patients' post-discharge outcomes under new payment models, hospitals may choose to acquire skilled nursing facilities (SNFs) to better manage these outcomes. This raises the question of whether patients discharged to hospital-based SNFs have better outcomes. In unadjusted comparisons, hospital-based SNF patients have much lower Medicare utilization in the 180 days following discharge relative to freestanding SNF patients. We solved the problem of differential selection into hospital-based and freestanding SNFs by using differential distance from home to the nearest hospital with a SNF relative to the distance from home to the nearest hospital without a SNF as an instrument. We found that hospital-based SNF patients spent roughly 5 more days in the community and 6 fewer days in the SNF in the 180 days following their original hospital discharge with no significant effect on mortality or hospital readmission.
Keywords: hospital-based SNF; post-acute care; Medicare; instrumental variables; patient outcomes
JEL Codes: I11; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| hospital-based SNF status (I19) | duration of care settings (I11) |
| hospital-based SNF status (I19) | Medicare spending (H51) |
| hospital-based SNF status (I19) | mortality (I12) |
| hospital-based SNF status (I19) | hospital readmission rates (I11) |