What happens when hospital-based skilled nursing facilities close? A propensity score analysis

Health Services Research, Dec, 2005 by Chapin White, Susanne Seagrave

Our analysis was limited to the early period of HBSNF closures before 2001. It is possible that some of the effects of the closures did not begin to occur until after this period, in which case we would be unable to document them. It is also possible that the closures that occurred in the 2 years or so after the implementation of the SNF prospective payment system were substantively different than closures that have occurred in more recent years. Thus, caution should be used in extrapolating these results to the more recent time period.

This analysis was limited by the types of data available in Medicare administrative records. Claims data provide detailed and accurate information on the utilization of services and provide some information on diagnoses, but do not provide any information on functional status (e.g., mobility, ability to dress oneself). For many HBSNF residents, the goal of treatment is to regain functional capacity after an acute episode such as a stroke, hip fracture, or coronary event. Improvement in functional capacity would, therefore, be the most direct measure of the success or failure of an HBSNF stay. Because we do not have direct measures of functional status, we instead use cruder outcome measures such as rehospitalization and mortality. Some measures of functional status are recorded in Medicare administrative data, such as the SNF Minimum Data Set-2.0 assessments and the Outcome and Assessment Information Set (OASIS) used by home health agencies. These functional status measures are currently being gathered but were not generally available in 1997 (our "pre" period). Furthermore, the functional status measures that exist in Medicare administrative data differ across sites of care, and are only gathered among individuals using a particular type of postacute care. These data features preclude the use of direct measures of functional status in the type of analysis presented here (i.e., one which focuses on substitution across sites of care).

ACKNOWLEDGMENTS

Chapin White acknowledges the National Institute on Aging (NIA) (Grant no. T32AG00186) for providing a postdoctoral training grant during the preparation of this paper. The authors also acknowledge the Medicare Payment Advisory Commission and the Centers for Medicare & Medicaid Services for support. Mark Miller, Sarah Thomas, and Sally Kaplan provided valuable comments.

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