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Shipping out instead of shaping up: Rehospitalization from nursing homes as an unintended effect of public reporting

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  • Konetzka, R. Tamara
  • Polsky, Daniel
  • Werner, Rachel M.

Abstract

Public reporting of health care quality has become a popular tool for incenting quality improvement. A fundamental question about public reporting is whether it causes providers to select healthier patients for treatment. In the nursing home post-acute setting, where patients must achieve a minimum length of stay to be included in quality measures, selection may take the form of discharge from the nursing home using rehospitalization, a particularly costly and undesirable outcome. We study the population of post-acute patients of skilled nursing facilities nationwide during 1999–2005 to assess whether selective rehospitalization occurred when public reporting was instituted in 2002, using multiple quasi-experimental designs to identify effects. We find that after public reporting was implemented, rehospitalizations before the length-of-stay cutoff increased. We conclude that nursing homes rehospitalize higher-risk post-acute patients to improve scores, providing evidence for selection behavior on the part of nursing home providers in the presence of public reporting.

Suggested Citation

  • Konetzka, R. Tamara & Polsky, Daniel & Werner, Rachel M., 2013. "Shipping out instead of shaping up: Rehospitalization from nursing homes as an unintended effect of public reporting," Journal of Health Economics, Elsevier, vol. 32(2), pages 341-352.
    • Handle: RePEc:eee:jhecon:v:32:y:2013:i:2:p:341-352
    DOI: 10.1016/j.jhealeco.2012.11.008
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    References listed on IDEAS

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    1. David C. Grabowski & Kate Stewart & Suzanne M. Broderick & Laura A. Coots, "undated". "Predictors of Nursing Home Hospitalization: A Review of the Literature," Mathematica Policy Research Reports 293a0c5e35ca433196b8853ca, Mathematica Policy Research.
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    4. repec:mpr:mprres:6215 is not listed on IDEAS
    5. Werner, Rachel M. & Norton, Edward C. & Konetzka, R. Tamara & Polsky, Daniel, 2012. "Do consumers respond to publicly reported quality information? Evidence from nursing homes," Journal of Health Economics, Elsevier, vol. 31(1), pages 50-61.
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    Citations

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    Cited by:

    1. Herr, Annika & Nguyen, Thu-Van & Schmitz, Hendrik, 2015. "Does quality disclosure improve quality? Responses to the introduction of nursing home report cards in Germany," DICE Discussion Papers 176, Heinrich Heine University Düsseldorf, Düsseldorf Institute for Competition Economics (DICE).
    2. Rebecca Mary Myerson & Darius Lakdawalla & Lisandro D. Colantonio & Monika Safford & David Meltzer, 2018. "Effects of Expanding Health Screening on Treatment - What Should We Expect? What Can We Learn?," NBER Working Papers 24347, National Bureau of Economic Research, Inc.
    3. Huang, Sean Shenghsiu & Hirth, Richard A., 2016. "Quality rating and private-prices: Evidence from the nursing home industry," Journal of Health Economics, Elsevier, vol. 50(C), pages 59-70.
    4. Martin B. Hackmann & R. Vincent Pohl & Nicolas R. Ziebarth, 2024. "Patient versus Provider Incentives in Long-Term Care," American Economic Journal: Applied Economics, American Economic Association, vol. 16(3), pages 178-218, July.
    5. Min M. Chen & David C. Grabowski, 2015. "Intended and Unintended Consequences of Minimum Staffing Standards for Nursing Homes," Health Economics, John Wiley & Sons, Ltd., vol. 24(7), pages 822-839, July.
    6. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.
    7. Elena Stancanelli, 2015. "Institutional long-term care and government regulation," IZA World of Labor, Institute of Labor Economics (IZA), pages 179-179, August.
    8. Rebecca Myerson & Darius Lakdawalla & Lisandro D. Colantonio & Monika Safford & David Meltzer, 2018. "Effects of expanding health screening on treatment – What should we expect? What can we learn?," Working Papers 2018-014, Human Capital and Economic Opportunity Working Group.
    9. Xiaoxue Li, 2020. "Quality information disclosure and health insurance demand: evidence from VA hospital report cards," International Journal of Health Economics and Management, Springer, vol. 20(2), pages 177-199, June.

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    More about this item

    Keywords

    Report cards; Quality; Information; Nursing home care; Patient selection;
    All these keywords.

    JEL classification:

    • L15 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Information and Product Quality
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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