Site of Death in the Hospital Versus Nursing Home of Medicare Skilled Nursing Facility Residents Admitted Under Medicare's Part A Benefit

Authors

  • Cari R. Levy MD,

    1. From the Divisions of *GeriatricsHealth Care Policy and Research, University of Colorado Health Sciences Center, Denver, Colorado.
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  • Ron Fish MBA,

    1. From the Divisions of *GeriatricsHealth Care Policy and Research, University of Colorado Health Sciences Center, Denver, Colorado.
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  • Andrew M. Kramer MD

    1. From the Divisions of *GeriatricsHealth Care Policy and Research, University of Colorado Health Sciences Center, Denver, Colorado.
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  • Dr. Levy is a recipient of the Hartford/AFAR Academic Fellowship Award. The data file was created under Centers for Medicare and Medicaid Services Contract 500–99-CO01 for the Data Analysis PRO. The content of the publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care and therefore did not require any special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.

Address correspondence to Cari Levy, MD, Division of Health Care Policy and Research, 13611 E. Colfax Avenue, Suite 100, Aurora, CO 80011. E-mail: cari.levy@uchsc.edu

Abstract

Objectives: To determine factors that predict site of death (hospital vs nursing home (NH)), related costs, and geographic variation in site of death of NH residents admitted under the Medicare Part A Benefit.

Design: Retrospective cohort study.

Setting: NHs located in the United States (N=13,146).

Participants: All persons admitted to skilled nursing facilities (SNFs) in 2001 who died in a SNF (n=101,307) or hospital (n=51,187).

Measurements: Patient, facility, and geographic characteristics associated with death in a hospital and receipt of Medicare payment.

Results: Absence of a do-not-resuscitate order, non-Caucasian ethnicity, greater functional independence, and higher cognitive status correlated with hospital as the site of death. Rural, hospital-based, and government-owned facilities had the lowest in-hospital death rates. Site of death varied widely from state to state. Of those who died in a hospital, 24.2% (12,410) died within 24 hours of transfer. The average daily combined stay Medicare payment for those who died in the hospital was $969, versus $300 for those who died in a NH.

Conclusion: Patient and facility characteristics predict site of death of Medicare NH patients, but in-hospital death rather than NH death varies geographically and is associated with higher daily Medicare payment.

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