Abstract
Objectives
The purpose of the study is to contribute to the literature regarding post-acute nursing
home utilization and quality indicators among Medicare beneficiaries in Puerto Rico
compared with the US mainland.
Design
Medicare data from 2015 to 2017 was used to identify new discharges to skilled nursing
facilities (SNFs) using the Minimum Data Set and the Medicare Provider Analysis and
Review.
Setting and Participants
Post-acute care patients admitted to SNFs in Puerto Rico and the United States.
Methods
Our final cohort included 4,732,222 beneficiaries from Puerto Rico and the United
States enrolled in Medicare fee-for-service or Medicare Advantage programs admitted
to an SNF (N = 15,197) following an acute hospital stay. We compared demographic,
clinical, and facility-level characteristics among patients in Puerto Rico and the
United States. We also described 2 quality indicators among these groups: (1) 30-day
rehospitalization rates and (2) successful discharge from the facility to the community.
Results
Medicare patients in Puerto Rico were physically and cognitively healthier than patients
in the United States. Puerto Ricans were also more likely to be admitted to lower
quality nursing homes than US patients (2.5 vs 3.4). Finally, Puerto Ricans had higher
rates of successful discharge to the community [17.6, 95% confidence interval (CI)
13.0-22.3], but higher 30-day rehospitalization rates compared with US patients (11.2,
95% CI 6.2-16.3). These differences were consistent even when comparing these quality
outcomes among Puerto Ricans to US Hispanics only.
Conclusions and Implications
SNFs in the United States and Puerto Rico are now receiving financial penalties for
high readmission rates. Currently, Medicare does not measure readmission rates for
Medicare Advantage patients—even though some states, including Puerto Rico, have a
high proportion of Medicare Advantage beneficiaries. As Medicare Advantage enrollment
continues to increase, our results highlight the importance of measuring performance
among Medicare Advantage patients and assessing disparities in quality of post-acute
care among patients in Puerto Rico and the United States.
Keywords
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Article info
Publication history
Published online: December 08, 2020
Footnotes
This work was supported by the National Institutes of Health (U54GM115677; R03AG054686 02; K01AG05782201A1)
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
