Address correspondence to Chapin White, M.P.P., Ph.D., Congressional Budget Office, Ford House Office Building, 4th Floor, Second and D Streets, SW, Washington, DC 20515-6925. Susanne Seagrave, Ph.D., is with the Centers for Medicare & Medicaid Services, Baltimore, MD.
What Happens When Hospital-Based Skilled Nursing Facilities Close? A Propensity Score Analysis
Version of Record online: 15 JUL 2005
Health Services Research
Volume 40, Issue 6p1, pages 1883–1897, December 2005
How to Cite
White, C. and Seagrave, S. (2005), What Happens When Hospital-Based Skilled Nursing Facilities Close? A Propensity Score Analysis. Health Services Research, 40: 1883–1897. doi: 10.1111/j.1475-6773.2005.00434.x
- Issue online: 15 JUL 2005
- Version of Record online: 15 JUL 2005
- skilled nursing facility;
- propensity score;
- postacute care
Objective. To assess the effects of hospital-based skilled nursing facility (HBSNF) closures on health care utilization, spending, and outcomes among Medicare fee-for-service beneficiaries.
Data Sources. One hundred percent Medicare fee-for-service claims files for 1997–2002 were merged with Medicare Provider of Services files and beneficiary-level enrollment records.
Study Design. Medicare spending, the use of postacute care, and health outcomes, were compared among hospitals that did and did not close their HBSNFs between 1997 and 2001. Hospitals were stratified according to propensity scores (i.e., predicted probability of closure from a logistic regression) and analyses were conducted within these strata.
Principal Findings. HBSNF closures were associated with increased utilization of alternative postacute care settings, and longer acute care hospital stays. Because of increased use of alternative settings, HBSNF closures were associated with a slight increase in total Medicare spending. There are no statistically robust associations between HBSNF closures and changes in either mortality or rehospitalization.
Conclusions. HBSNF closures altered utilization patterns, but there is no indication that closures adversely affect beneficiaries' health outcomes.