Many Older Americans Do Not Receive the Recommended Home Health Care After Hospitalization

Only 54% of Medicare patients referred to home health care services following a hospitalization received home health care visits. Policymakers must address this discrepancy to ensure all patients receive the home health services they need

Changes in Consumer Demand Following Public Reporting of Summary Quality Ratings: An Evaluation in Nursing Homes

A nursing home report card that converted 12 measures of quality into a simple 5-star system significantly affected consumer demand for low- and high-scoring facilities. One-star facilities typically lost 8 percent of their market share and 5-star facilities gained more than 6 percent of their market share. These results support the use of summary measures in report cards

Physicians and Advanced Practitioners Specializing in Nursing Home Care, 2012-2015

The number of clinicians specializing in nursing home care increased by 33.7% from 2012 to 2015, although nursing home specialists made up only 21% of nursing home clinicians in 2015. Most of these specialists were advanced practitioners (physician assistants and nurse practitioners) delivering post-acute care. The change in number of nursing home specialists varied significantly by geographic region

The Pay-Off on Nursing Home Report Cards

For the past decade, policymakers have used public reporting of quality measures as a strategy to improve quality in nursing homes. In theory, public reporting might improve overall quality in two ways: first, if consumers choose nursing homes with better performance, and second, if public reporting encourages nursing homes to improve their performance. Has public reporting had its intended effects? Does improving quality give nursing homes a competitive advantage in the marketplace, thereby improving their bottom line? This Issue Brief summarizes a series of studies that assess the impact of public reporting on nursing home quality and on the financial performance of these facilities

Physician Consolidation and the Spread of Accountable Care Organizations

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger

Hospital Performance Measures and Quality of Care

Increasingly, quality improvement initiatives emphasize public reporting of hospital performance measures, to encourage providers to improve, to help consumers pick providers, and to determine provider payments. Although these measures are based on compliance with well established processes of care, it is unknown whether quality measured in this way is correlated with, or predictive of, clinical outcomes. This Issue Brief summarizes studies that examine and quantify the relationship between frequently used measures of hospital performance and hospital mortality

Long-Term Care Policy after Covid-19 — Solving the Nursing Home Crisis

Nursing homes have been caught in the crosshairs of the coronavirus pandemic. As of early May 2020, Covid-19 had claimed the lives of more than 28,000 nursing home residents and staff in the United States. But U.S. nursing homes were unstable even before Covid-19 hit. The tragedy unfolding in nursing homes is the result of decades of neglect of long-term care policy.Beyond the pandemic, we will have to transform the way we pay for and provide long-term care. First, Medicaid programs need to invest considerably more in care in all settings, including home-based settings as Medicaid shifts a larger share of care into them. Second, because caregiving at home is not feasible for many care recipients and families, we also need safe, affordable residential options. Better residential options can help ensure that the tragedy currently unfolding in nursing homes never happens again. Finally, we believe that the United States needs to reconsider our piecemeal approach to paying for long-term care. Existing programs, such as Medicare and Medicaid, would have to fundamentally change the way they pay for long-term care to meet the needs of our aging population. We can look to other countries for more coherent financing systems.More funding alone is not the answer. Nor is more regulation a sufficient response. Rather, we need a combination of funding, regulation, and a new strategy that fully supports a range of institutional and noninstitutional care

The Effect of Integration of Hospitals and Post-Acute Care Providers on Medicare Payment and Patient Outcomes

Vertical integration between hospitals and skilled nursing facilities (SNFs) increases Medicare payments for the first 60 days of care by $2,424 (17%), compared to hospital-SNF pairs that are not vertically integrated. These integrated hospital–SNF pairs also experience a decline in 30-day rates of rehospitalization or death of 5 percentage points on a base rate of 31.3%. Vertical integration between hospitals and home health agencies (HHAs) has little effect on Medicare payments and patient outcomes, nor does informal integration in either setting

Physicians’ Participation in ACOs is Lower in Places With Vulnerable Populations Than in More Affluent Communities

In 2013, physician participation in accountable care organizations (ACOs) was inversely related to the percentage of the local population that was black, living in poverty, uninsured, or disabled or that had less than a high school education. This risks exacerbating disparities in the quality of care received by these vulnerable populations