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J Health Econ. 2013 Mar;32(2):341-52. doi: 10.1016/j.jhealeco.2012.11.008. Epub 2012 Dec 3.

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

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University of Chicago, 5841 S. Maryland, MC2007, Chicago, IL 60637, USA.


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.

[Indexed for MEDLINE]

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