Patient Routing to Skilled Nursing Facilities: The Consequences of the Medicare Reimbursement Rule

Published Online:https://doi.org/10.1287/mnsc.2022.4316

References

  • Adida E, Mamani H, Nassiri S (2016) Bundled payment vs. fee-for-service: Impact of payment scheme on performance. Management Sci. 63(5):1606–1624.LinkGoogle Scholar
  • Andritsos DA, Tang CS (2018) Incentive programs for reducing readmissions when patient care is co‐produced. Production Oper. Management 27(6):999–1020.CrossrefGoogle Scholar
  • Angrist JD, Pischke JS (2008) Mostly Harmless Econometrics: An Empiricist’s Companion (Princeton University Press, Princeton, NJ).CrossrefGoogle Scholar
  • Armony M, Chan CW, Zhu B (2018) Critical care capacity management: Understanding the role of a stepdown unit. Production Oper. Management 27(5):859–883.CrossrefGoogle Scholar
  • Batt R, Bavafa H, Soltani S (2020) Quality improvement spillovers: Evidence from the Hospital Readmissions Reduction Program. Preprint, submitted August 12, https://dx.doi.org/10.2139/ssrn.3132770.Google Scholar
  • Boehme AK, Kulick ER, Canning M, Alvord T, Khaksari B, Omran S, Willey JZ, et al. (2018) Infections increase the risk of 30-day readmissions among stroke survivors: Analysis of the National Readmission Database. Stroke 49(12):2999–3005.CrossrefGoogle Scholar
  • Brickley JA, Lu SF, Wedig GJ (2017) Malpractice laws and incentives to shield assets: evidence from nursing homes. J. Empirical Legal Stud. 14(2):301–332.CrossrefGoogle Scholar
  • Castle NG, Ferguson JC (2010) What is nursing home quality and how is it measured? Gerontologist 50(4):426–442.CrossrefGoogle Scholar
  • Centers for Medicare and Medicaid Services (CMS) (2017) 2015 measure information about the hospital admissions for Acute and Chronic Ambulatory Care-Sensitive Condition (ACSC) composite measures, calculated for the 2017 Value-Based Payment Modifier Program.Google Scholar
  • Centers for Medicare and Medicaid Services (CMS) (2021a) Skilled nursing facility 3-day rule billing: MLN Fact Sheet. Accessed September 2021, https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SNF3DayRule-MLN9730256.pdf.Google Scholar
  • Centers for Medicare and Medicaid Services (CMS) (2021b) Skilled nursing facility 3-day rule. Accessed September 2021, https://www.cms.gov/medicare/medicare-fee-for-service-payment/sharedsavingsprogram/downloads/snf-waiver-guidance.pdf. https://www.cms.gov/medicare/medicare-fee-for-service-payment/sharedsavingsprogram/downloads/snf-waiver-guidance.Google Scholar
  • Chan CW, Green LV, Lekwijit S, Lu L, Escobar G (2018) Assessing the impact of service level when customer needs are uncertain: An empirical investigation of hospital step-down units. Management Sci. 65(2):751–775.LinkGoogle Scholar
  • Chen C, Savva N (2018) Unintended consequences of hospital regulation: the case of the hospital readmissions reduction program. Preprint, submitted August 22, https://dx.doi.org/10.2139/ssrn.3236983.Google Scholar
  • Currie J, MacLeod WB (2017) Diagnosing expertise: Human capital, decision making, and performance among physicians. J. Labor Econom. 35(1):1–43.CrossrefGoogle Scholar
  • Currie J, Slusky D (2020) Does the marginal hospitalization save lives? The case of respiratory admissions for the elderly. NBER Working Paper 26618, National Bureau of Economic Research, Cambridge, MAGoogle Scholar
  • Currie J, MacLeod WB, Van Parys J (2016) Provider practice style and patient health outcomes: The case of heart attacks. J. Health Econom. 47:64–80.CrossrefGoogle Scholar
  • Doyle J, Graves J, Gruber J (2017) Uncovering waste in U.S. healthcare. J. Health Econom. 54:25–39.CrossrefGoogle Scholar
  • Einav L, Finkelstein A, Mahoney N (2018a) Provider incentives and healthcare costs: Evidence from long-term care hospitals. Econometrica 86(6):2161–2219.CrossrefGoogle Scholar
  • Einav L, Finkelstein A, Mahoney N (2018b) Long term care hospitals: A case study in waste. NBER Working Paper 249496, National Bureau of Economic Research, Cambridge, MA.Google Scholar
  • Eliason P, Grieco P, McDevitte R, Roberts J (2018) Strategic patient discharge: Evidence from long-term care hospitals. Amer. Econom. Rev. 108(11):3232–3265.CrossrefGoogle Scholar
  • Fan Y, Wang J, Xie J, Yu Y (2018) The impact of bundled payment policy on hospital operations: Evidence from China. Working paper, University of Science and Technology of China, Hefei, China.Google Scholar
  • Freeman M, Robinson S, Scholtes S (2021) Gatekeeping, fast and slow: An empirical study of referral errors in the emergency department. Management Sci. 67(7):4209–4232.LinkGoogle Scholar
  • Freeman M, Savva N, Scholtes S (2016) Gatekeepers at work: An empirical analysis of a maternity unit. Management Sci. 63(10):3147–3167.LinkGoogle Scholar
  • Grabowski DC, Gruber J, Angelelli JJ (2008) Nursing home quality as a common good. Rev. Econom. Statist. 90(4):754–764.CrossrefGoogle Scholar
  • Grebla RC, Keohane L, Lee Y, Lipsitz LA, Rahman M, Trivedi AN (2015) Waiving the three-day rule: Admissions and length-of-stay at hospitals and skilled nursing facilities did not increase. Health Aff. 34(8):1324–1330.CrossrefGoogle Scholar
  • Greene W (2004) Fixed effects and bias due to the incidental parameters problem in the Tobit model. Econometric Rev. 23(2):125–147.CrossrefGoogle Scholar
  • Guo P, Tang CS, Wang Y, Zhao M (2018) The impact of reimbursement policy on social welfare, revisit rate, and waiting time in a public healthcare system: Fee-for-service vs. bundled payment. Manufacturing Service Oper. Management 21(1):154–170.LinkGoogle Scholar
  • Gupta D, Mehrotra M (2015) Bundled payments for healthcare services: Proposer selection and information sharing. Oper. Res. 63(4):772–788.LinkGoogle Scholar
  • He H, Garcia EA (2009) Learning from imbalanced data. IEEE Trans. Knowledge Data Engrg. 21(9):1263–1284.CrossrefGoogle Scholar
  • Heckman JJ (1987) The Incidental Parameters Problem and the Problem of Initial Conditions in Estimating a Discrete Time-Discrete Data Stochastic Process and Some Monte Carlo Evidence (University of Chicago Center for Mathematical Studies in Business and Economics, Chicago).Google Scholar
  • Katz E (2001) Bias in conditional and unconditional fixed effects logit estimation. Polit. Anal. 9(4):379–384.CrossrefGoogle Scholar
  • KC DS (2020) Heuristic thinking in patient care. Management Sci. 66(6):2545–2563.Google Scholar
  • KC DS, Terwiesch C (2017) Benefits of surgical smoothing and spare capacity: An econometric analysis of patient flow. Production Oper. Management 26(9):1663–1684.CrossrefGoogle Scholar
  • KC DS, Scholtes S, Terwiesch C (2020) Empirical research in healthcare operations: past research, present understanding, and future opportunities. Manufacturing Service Oper. Management 22(1):73–83.LinkGoogle Scholar
  • Keswani A, Tasi MC, Fields A, Lovy AJ, Moucha CS, Bozic KJ (2016) Discharge destination after total joint arthroplasty: An analysis of postdischarge outcomes, placement risk factors, and recent trends. J. Arthroplasty 31(6):1155–1162.CrossrefGoogle Scholar
  • Kim SH, Chan CW, Olivares M, Escobar G (2015) ICU admission control: An empirical study of capacity allocation and its implication for patient outcomes. Management Sci. 61(1):19–38.LinkGoogle Scholar
  • Krawczyk B (2016) Learning from imbalanced data: Open challenges and future directions. Progress Artificial Intelligence 5(4):221–232.CrossrefGoogle Scholar
  • Li Y, Lu LX, Lu SF (2021) Do social media dominate government report cards in influencing nursing home demand? Preprint, submitted July 2, https://dx.doi.org/10.2139/ssrn.3531964.Google Scholar
  • Lu LX, Lu SF (2018) Distance, quality, or relationship? Interhospital transfer of heart attack patients. Production Oper. Management 27(12):2251–2269.CrossrefGoogle Scholar
  • Lu SF, Rui H, Seidmann A (2018) Does technology substitute for nurses? Staffing decisions in nursing homes. Management Sci. 64(4):1842–1859.LinkGoogle Scholar
  • Mahomed NN, Davis AM, Hawker G, Badley E, Davey JR, Syed KA, Coyte PC, et al. (2008) Inpatient compared with home-based rehabilitation following primary unilateral total hip or knee replacement: A randomized controlled trial. J. Bone Joint Surg. Amer. 90(8):1673–1680.CrossrefGoogle Scholar
  • Medicare Payment Advisory Commission (MEDPAC) (2020) A DATA BOOK: Health Care Spending and the Medicare Program Section 8: Post-Acute Care (MEDPAC, Washington, DC).Google Scholar
  • Rose L (2020) The effects of skilled nursing facility care: Regression discontinuity evidence from Medicare. Amer. J. Health Econom. 6(1):39–71.CrossrefGoogle Scholar
  • Savva N, Tezcan T, Yıldız Ö (2019) Can yardstick competition reduce waiting times? Management Sci. 65(7):3196–3215.LinkGoogle Scholar
  • Werner RM, Coe NB, Qi M, Tamara Konetzka R (2019) Patient outcomes after hospital discharge to home with home health care vs to a skilled nursing facility. JAMA Intern. Med. 179(5):617–623.CrossrefGoogle Scholar
  • Wooldridge JM (2010) Econometric Analysis of Cross Section and Panel Data (MIT Press, Cambridge, MA).Google Scholar
  • Zhang DJ, Gurvich I, Van Mieghem JA, Park E, Young RS, Williams MV (2016) Hospital readmissions reduction program: An economic and operational analysis. Management Sci. 62(11):3351–3371.LinkGoogle Scholar
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