![]() ![]() ![]() In 2015, Medicare fee-for-service spending for post-acute care stays accounted for $29.8 billion, 6 and state Medicaid programs spent $54.8 billion on long-term care in nursing homes. Nursing home care accounts for significant Medicare and Medicaid spending. Most nursing homes in the United States provide 2 distinct types of services: (1) post-acute care to patients who require short-term rehabilitation or skilled nursing care after discharge from the hospital and (2) long-term care to patients with significant functional impairments who are no longer able to manage independently in the community. Nursing homes represent an important group of health care providers that are subject to public reporting. Although some early studies found evidence that public reporting was associated with quality gains by hospitals, 1 nursing homes, 2 - 4 and individual providers, 5 these findings were not consistent across settings. That is, the average quality of care patients receive should increase as high-quality providers gain more market share and low-quality providers work to improve their performance to avoid losing market share. By measuring and then making provider quality information publicly available to patients and referring providers, public reporting aims to improve health care quality through competition. Public reporting of health care provider quality is often promoted as an effective means to improve patient outcomes and has thus been broadly embraced by private and public payers. Although this dissociation may be due to better matching of sicker patients to higher-quality nursing homes or superficial improvements by nursing homes to increase their ratings without substantial investments in quality improvement, the 5-star ratings nonetheless became less meaningful as an indicator of nursing home quality for post-acute care patients. The improvements in nursing home star ratings after the release of Medicare’s 5-star rating system were not accompanied by improvements in a broader measure of outcomes for post-acute care patients. This decrease in correlation was concentrated among patients receiving post-acute care, who experienced relatively more hospitalizations from best-rated nursing homes. The correlation between the rate of hospitalization and a nursing home’s 5-star rating weakened slightly after the ratings became publicly available. We used 2007-2010 Medicare hospital claims and nursing home clinical assessment data to compare the correlation between nursing home 5-star ratings and hospitalization rates before versus after 5-star ratings were publicly released. We hypothesized that increased attention to 5-star star ratings motivated nursing homes to make changes that improved their star ratings but did not affect their hospitalization rate, resulting in a weakened association between ratings and hospitalizations. Our objective was to test whether the improvements in nursing home 5-star ratings were correlated with reductions in rates of hospitalization. Nursing homes’ publicly reported star ratings increased substantially since Centers for Medicare & Medicaid Services’s Nursing Home Compare adopted a 5-star rating system. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |