Advertisement

Trends in Post-Acute Care in US Nursing Homes: 2001-2017

      Abstract

      Objective

      To describe recent trends in post-acute care provision within nursing homes, focusing specifically on nursing homes’ degree of specialization in post-acute care.

      Design

      Retrospective cohort study.

      Setting and Participants

      All US nursing homes between 2001 and 2017 and all fee-for-service Medicare admissions to nursing homes for post-acute care during that time.

      Methods

      We measured post-acute care specialization as annual Medicare admissions per bed for each nursing home and examined changes in the distribution of specialization across nursing homes over the study period. We described the characteristics of nursing homes and the patients they serve based on degree of specialization.

      Results

      The average number of Medicare admissions per bed increased from 1.2 in 2001 to 1.6 in 2017, a relative increase of 41%. This upward trend in the number of Medicare admissions per bed was largest among new nursing homes (those established after 2001), increasing 68% from 2001 to 2017. In contrast, nursing homes that eventually closed during the study period experienced no meaningful growth in the number of admissions per bed. Over time, the number of Medicare admissions per bed increased among highly specialized nursing homes. The number of Medicare admissions per bed grew by 66% at the 95th percentile and by 25% at the 99th percentile. Nursing homes delivering the most post-acute care were more likely to be for-profit or part of a chain, had higher staffing levels, and were less likely to admit patients who were Black, Hispanic, or dually enrolled in Medicare and Medicaid.

      Conclusions and Implications

      Over the last 2 decades, post-acute care has become increasingly concentrated in a subset of nursing homes, which tend to be for-profit, part of a chain, and less likely to serve racial and ethnic minorities and persons on Medicaid. Although these nursing homes may benefit financially from higher Medicare payment, it may come at the expense of equitable access and patient care.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. MedPAC. Report to the Congress: Medicare Payment Policy. Medicare Payment Advisory Commission, Washington, DC2020
        • Liao J.M.
        • Konetzka R.T.
        • Werner R.M.
        Trends in hospital-SNF relationships in the care of Medicare beneficiaries.
        Healthc (Amst). 2018; 6: 175-179
        • Konetzka R.T.
        • Stuart E.A.
        • Werner R.M.
        The effect of integration of hospitals and post-acute care providers on Medicare payment and patient outcomes.
        J Health Econ. 2018; 61: 244-258
        • Tyler D.A.
        • Feng Z.
        • Leland N.E.
        • et al.
        Trends in postacute care and staffing in US nursing homes, 2001–2010.
        J Am Med Dir Assoc. 2013; 14: 817-820
        • Brown University
        LTC Focus. Shaping long-term care in America project web site.
        (Available at:)
        http://ltcfocus.org/
        Date accessed: December 2, 2020
        • Rahman M.
        • Gadbois E.A.
        • Tyler D.A.
        • Mor V.
        Hospital–skilled nursing facility collaboration: A mixed-methods approach to understanding the effect of linkage strategies.
        Health Serv Res. 2018; 53: 4808-4828
        • Begley T.A.
        • Weagley D.
        Firm finances and the spread of COVID-19: Evidence from nursing homes. Georgia Tech Scheller College of Business Research Paper No. 3659480.
        (Available at:)
        https://ssrn.com/abstract=3659480
        Date: 2021
        Date accessed: July 12, 2021
        • Troyer J.L.
        Cross-subsidization in nursing homes: Explaining rate differentials among payer types.
        South Econ J. 2002; 68: 750-773
        • Comondore V.R.
        • Devereaux P.
        • Zhou Q.
        • et al.
        Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.
        BMJ. 2009; 339: b2732
        • Clark J.R.
        • Huckman R.S.
        Broadening focus: Spillovers, complementarities, and specialization in the hospital industry.
        Manag Sci. 2012; 58: 708-722
        • Huckman R.S.
        • Zinner D.E.
        Does focus improve operational performance? Lessons from the management of clinical trials.
        Strategic Manag J. 2008; 29: 173-193
        • Doyle J.J.
        Physician characteristics and patient survival: Evidence from physician availability.
        NBER Working Paper, No. 27458, Cambridge, MA, 2020
        • Ayanian J.Z.
        • Hauptman P.J.
        • Guadagnoli E.
        • et al.
        Knowledge and practices of generalist and specialist physicians regarding drug therapy for acute myocardial infarction.
        N Engl J Med. 1994; 331: 1136-1142
        • Zaman M.J.
        • Fleetcroft R.
        • Bachmann M.
        • et al.
        Association of increasing age with receipt of specialist care and long-term mortality in patients with non-ST elevation myocardial infarction.
        Age Ageing. 2016; 45: 96-103
        • Uthamalingam S.
        • Kandala J.
        • Selvaraj V.
        • et al.
        Outcomes of patients with acute decompensated heart failure managed by cardiologists versus noncardiologists.
        Am J Cardiol. 2015; 115: 466-471
        • Gillum L.A.
        • Johnston S.C.
        Influence of physician specialty on outcomes after acute ischemic stroke.
        J Hosp Med. 2008; 3: 184-192
        • Chandra A.
        • Staiger D.O.
        Productivity spillovers in health care: Evidence from the treatment of heart attacks.
        J Polit Econ. 2007; 115: 103-140
        • Birkmeyer J.D.
        • Stukel T.A.
        • Siewers A.E.
        • et al.
        Surgeon volume and operative mortality in the United States.
        N Engl J Med. 2003; 349: 2117-2127
        • Rahman M.
        • Norton E.C.
        • Grabowski D.C.
        Do hospital-owned skilled nursing facilities provide better post-acute care quality?.
        J Health Econ. 2016; 50: 36-46
        • Park Y.J.
        • Martin E.G.
        Geographic disparities in access to nursing home services: Assessing fiscal stress and quality of care.
        Health Serv Res. 2018; 53: 2932-2951
        • Smith D.B.
        • Feng Z.
        • Fennell M.L.
        • et al.
        Separate and unequal: Racial segregation and disparities in quality across U.S. nursing homes.
        Health Aff (Millwood). 2007; 26: 1448-1458