Working Paper: NBER ID: w25940
Authors: Portia Y. Cornell; David C. Grabowski; Edward C. Norton; Momotazur Rahman
Abstract: Report cards on provider performance are intended to improve consumer decision-making and address information gaps in the market for quality. However, inadequate risk adjustment of report-card measures often biases comparisons across providers. We test whether going to a skilled nursing facility (SNF) with a higher star rating affects outcomes for a patient. We exploit variation over time in the distance from a patient’s residential ZIP code to SNFs with different ratings to estimate the causal effect of admission to a higher-rated SNF on health care outcomes, including mortality. We found that patients who go to higher-rated SNFs experience lower mortality, fewer days in the nursing home, and fewer hospital readmissions.
Keywords: skilled nursing facilities; report cards; healthcare quality; Medicare; 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 |
|---|---|
| Higher star ratings (C52) | Mortality rates within 30 days (I12) |
| Higher star ratings (C52) | Mortality rates within 180 days (I12) |
| Higher star ratings (C52) | Hospital readmissions within 30 days (I11) |
| Higher star ratings (C52) | Hospital readmissions within 180 days (I11) |
| Higher star ratings (C52) | Probability of becoming a long-stay resident (more than 100 days) (C41) |