Identifying Associations between Quality Initiatives and Quality Measures among Home Health Agencies: Findings from a National Study.

Home health performance gained visibility with the publication of Home Health Compare and the Home Health Value-Based Payment demonstration. Both provide incentives for home health agencies (HHA) to invest in quality improvements. The objective of this study is to identify the association between quality initiatives adopted by HHAs and improved performance.

Home Health Care Quality, Its Costs and Implications for Home Health Value-Based Purchasing.

The Home Health Value-based Purchasing (HHVBP) demonstration, incorporating a payment formula designed to incentivize both high-quality care and quality improvement, is expected to become a national program after 2022, when the demonstration ends. This study investigated the relationship between costs and several quality dimensions, to inform HHVBP policy. Using Medicare cost reports, OASIS and Home Health Compare data for 7,673 home health agencies nationally, we estimated cost functions with instrumental variables for quality.

Certificate of need and the cost of competition in home healthcare markets.

We used 2010-16 Medicare Cost Reports for 10,737 freestanding home health agencies (HHAs) to examine the impact of home health (HH) and nursing home (NH) certificate-of-need (CON) laws on HHA caseload, total and per-patient variable costs. After adjusting for other HHA characteristics, total costs were higher in states with only HH CON laws ($2,975,698), only NH CON laws ($1,768,097), and both types of laws ($3,511,277), compared with no CON laws ($1,538,536). Higher costs were driven by caseloads, as CON reduced per-patient costs.

Moving organizational theory in health care forward: A discussion with suggestions for critical advancements.

In May 2019, scholars in management and organization of health care organizations and systems met. The opening plenary was a moderated discussion with five distinguished scholars who have exemplified pushing the frontier of organizational theory and practice throughout their careers: Ann Barry Flood of Dartmouth College, John Kimberly of the University of Pennsylvania, Anthony (Tony) Kovner of New York University, Stephen (Steve) Shortell of University of California at Berkeley, and Jacqueline (Jackie) Zinn of Temple University. The discussion was moderated by Ingrid Nembhard of the University of Pennsylvania.

Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities.

Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network.

The Impact of Certificate-of-Need Laws on Nursing Home and Home Health Care Expenditures.

Over the past two decades, nursing homes and home health care agencies have been influenced by several Medicare and Medicaid policy changes including the adoption of prospective payment for Medicare-paid postacute care and Medicaid-paid long-term home and community-based care reforms. This article examines how spending growth in these sectors was affected by state certificate-of-need (CON) laws, which were designed to limit the growth of providers and have remained unchanged for several decades. Compared with states without CON laws, Medicare and Medicaid spending in states with CON laws grew faster for nursing home care and more slowly for home health care.

Post-acute integration strategies in an era of accountability.

The Institute of Medicine, in its 2001 Crossing the Quality Chasm report, recommended greater integration and coordination as a component of a transformed health care system, yet relationships between acute and post-acute providers have remained weak. With payment reforms that hold hospitals and health systems accountable for the total costs of care and readmissions, the dynamic between acute and post-acute providers is changing. In this article, we outline the internal and market factors that will drive health systems' decisions about whether and how they integrate with post-acute providers.

Effect of hospital-SNF referral linkages on rehospitalization.

Objective: To determine whether the rate of rehospitalization is lower among patients discharged to skilled nursing facilities (SNFs) with which a hospital has a strong linkage.

Data Sources/collection: We used national Medicare enrollment, claims, and the Minimum Data Set to examine 2.8 million newly discharged patients to 15,063 SNFs from 2,477 general hospitals between 2004 and 2006.

The impact of hospital-based skilled nursing facility closures on rehospitalizations.

Objective: To examine the effect of reductions in hospital-based (HB) skilled nursing facility (SNF) bed supply on the rate of rehospitalization of patients discharged to any SNF from zip codes that lost HB beds.

Data Source: We used Medicare enrollment records, Medicare hospital and SNF claims, and nursing home Minimum Dataset assessments and characteristics (OSCAR) to examine nearly 10 million Medicare fee-for-service hospital discharges to SNFs between 1999 and 2006.

Study Design: We calculated the number of HB and freestanding (FS) SNF beds within a 22 km radius from the centroid of all zip codes in which Medicare beneficiaries reside in all years.

Factors influencing nursing home response to quality measure publication: A resource dependence perspective.

Background: The Centers for Medicare and Medicaid Services provides a report card on nursing homes at a Web site called Nursing Home Compare (NHC) that includes information on 19 clinical quality measures (QMs). The information is intended to inform consumer choice, to provide a focus for state regulatory initiatives, and to promote nursing home quality improvement efforts.

Purpose: This study aimed to determine what factors were associated with nursing homes' investment in quality after publication of the NHC report card.

Is there evidence of cream skimming among nursing homes following the publication of the Nursing Home Compare report card?

Purpose: A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream skimming admission policies.

Does risk adjustment of the CMS quality measures for nursing homes matter?

Background: The Centers for Medicare and Medicaid Services (CMS) publish a report card for nursing homes with 19 clinical quality measures (QMs). These measures include minimal risk adjustment.

Objectives: To develop QMs with more extensive risk adjustment and to investigate the impact on quality rankings.

Strategic orientation and nursing home response to public reporting of quality measures: an application of the miles and snow typology.

Objective: To assess whether differences in strategic orientation of nursing homes as identified by the Miles and Snow typology are associated with differences in their response to the publication of quality measures on the Nursing Home Compare website.

Data Sources: Administrator survey of a national 10 percent random sample (1,502 nursing homes) of all facilities included in the first publication of the Nursing Home Compare report conducted in May-June 2004; 724 responded, yielding a response rate of 48.2 percent.

Publication of quality report cards and trends in reported quality measures in nursing homes.

Objective: To examine associations between nursing homes' quality and publication of the Nursing Home Compare quality report card.

Data Sources/study Settings: Primary and secondary data for 2001-2003: 701 survey responses of a random sample of nursing homes; the Minimum Data Set (MDS) with information about all residents in these facilities, and the Nursing Home Compare published quality measure (QM) scores.

Study Design: Survey responses provided information on 20 specific actions taken by nursing homes in response to publication of the report card.

Hospital inefficiency: what is the impact of membership in different types of systems?

The primary objective of this study is to assess whether systematic differences in inefficiency are associated with hospital membership in different types of systems. We employed the Battese/Coelli simultaneous stochastic frontier analysis (SFA) technique to estimate hospital cost inefficiency. Mean estimated inefficiency was 8.

Separate and unequal: racial segregation and disparities in quality across U.S. nursing homes.

We describe the racial segregation in U.S. nursing homes and its relationship to racial disparities in the quality of care.

Nursing homes' response to the nursing home compare report card.

Objective: The Centers for Medicare and Medicaid Services have recently begun publishing the Nursing Home Compare report card. The objective of this study was to examine the initial reactions of nursing homes to publication of the report card and to evaluate the impact of the report card on quality-improvement activities.

Methods: We conducted a survey of a random national sample of 1,502 nursing home administrators; 724 responded.

Doing better to do good: the impact of strategic adaptation on nursing home performance.

Objective: To test the hypothesis that a greater commitment to strategic adaptation, as exhibited by more extensive implementation of a subacute/rehabilitation care strategy in nursing homes, will be associated with superior performance.

Data Sources: Online Survey, Certification, and Reporting (OSCAR) data from 1997 to 2004, and the area resource file (ARF).

Study Design: The extent of strategic adaptation was measured by an aggregate weighted implementation score.

The use of contract licensed nursing staff in U.S. nursing homes.

The extent to which nursing homes rely on the use of contracted licensed staff, factors associated with this staffing practice, and the resultant effect on the quality of resident care has received little public attention. Merging the On-line Survey Certification and Reporting System database with the Area Resource File from 1992 through 2002, the authors regressed organizational and market-level variables on the use of 5 percent or more contract full-time equivalent registered nurses and licensed practical nurses. Since 1997, the proportion of facilities using 5 percent or more contract licensed staff more than tripled.