Report Cards for Skilled Nursing Facilities

As we have noted in several recent posts, the agency that administers Medicare has several “report cards” for different provider types, which are supposed to inform patients about the relative quality delivered by the provider.  A study in the Journal of Health Economics examined whether the skilled nursing facility report card appeared to predict future quality.  (JHE Article)  Most report cards are obviously reflecting the measurement of past performance and the question is whether that gives us a guide to future performance.  The skilled nursing facility report card relies heavily on health inspection measures, with additional measures on staffing and quality.  As with all the CMS report cards, there have been concerns about accuracy and utility.  Skilled nursing facilities have a history of often poor care, so patients and referring physicians might have a keen interest in this data.  Patient selection concerns create difficulty in assessing connections between outcomes and star ratings.  The researchers attempt to overcome this by using the distance from a patient’s home to a facility with a particular rating and assessing the effect on mortality of selecting a SNF with an additional star in the rating.

The primary outcomes were mortality following the skilled nursing facility admission and utilization after the admission of a several categories of care.  A preliminary finding was that patients were more likely to choose SNFs closer to their home, without regard to rating, but also were more likely to travel further to get to a higher-rated SNF than a lower-rated one.  And under this analysis, it appears that going to a higher-rated facility is associated with better outcomes.  Going to a SNF with one additional star leads to a decline in the likelihood of death within 30 days and within 180 days of the SNF admission of around 6% and 5%, respectively.  And it decreases the likelihood of a nursing home stay of over 100 days by around 5%.   There were also fewer hospital readmissions and more days at home.   The authors point out that few patients, or their prescribing physicians, appear to use the ratings, and that CMS should do more to publicize their value and encourage the use of higher-rated facilities, even if the patient is further from home.