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Outcomes After Shortened Skilled Nursing Facility Stays Suggest Potential For Improving Postacute Care Efficiency.

Authors
  • McGarry, Brian E1
  • Grabowski, David C2
  • Ding, Lin3
  • McWilliams, J Michael4
  • 1 Brian E. McGarry is an assistant professor in the Department of Medicine, University of Rochester, in Rochester, New York.
  • 2 David C. Grabowski is a professor of health care policy in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts.
  • 3 Lin Ding is a biostatistician in the Department of Health Care Policy, Harvard Medical School.
  • 4 J. Michael McWilliams ([email protected]) is the Warren Alpert Foundation Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School and a professor of medicine and general internist at Brigham and Women's Hospital, in Boston, Massachusetts.
Type
Published Article
Journal
Health affairs (Project Hope)
Publication Date
May 01, 2021
Volume
40
Issue
5
Pages
745–753
Identifiers
DOI: 10.1377/hlthaff.2020.00649
PMID: 33939502
Source
Medline
Language
English
License
Unknown

Abstract

Reducing postacute care in skilled nursing facilities (SNFs) in favor of home-based care is a leading cost-saving strategy in new payment models. Yet the extent to which SNF stays can be safely shortened remains unclear. We leveraged the exposure of fee-for-service Medicare beneficiaries without supplemental coverage to cost sharing after SNF benefit day 20 as a cause of shortened stays. Marked reductions in length-of-stay because of cost sharing shifted patients to home more than a week earlier than expected without cost sharing, producing a discharge spike. These reductions were not associated with clear evidence of compromised patient safety as measured by death, hospitalization for fall-related injuries, or all-cause hospitalization within nine days of the spike. Adverse consequences requiring hospitalization could not be excluded for a small proportion of shortened stays. These findings suggest potential for improving postacute care efficiency, as SNF stays may be unnecessarily long to ensure safety.

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