Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120
Presentation
The impact of public reporting on quality of post-acute care
Recent evidence about the poor quality of health care delivered in the US has caused concern among health care consumers, providers, and policymakers. In an effort to improve health care quality, policymakers have recently turned to market-based reforms across the health care system, such as web-based public reporting of quality measures and pay-for-performance strategies. For example, the Centers for Medicare and Medicaid Services (CMS) reports health care quality through their websites, such as Nursing Home Compare, which publicly rates nursing homes based on their performance on certain quality measures. Market-based reforms are designed to improve health care quality in two ways. First, both public reporting and pay-for-performance may motivate improvements in the quality of individual providers, increasing provider-specific quality of care. Second, if quality information is publicly reported, it may increase the likelihood that patients select high-quality providers, thus increasing the number of patients receiving high-quality care. If quality reforms have either of these effects, overall quality of care will improve.
Despite the enthusiasm for market-based reforms to improve quality and the widespread adoption of these methods, it is unknown whether these efforts truly improve quality of care or whether improvements will occur across all providers, regardless of the resources available to improve quality. Measurement of quality improvement is complicated by the difficulty in determining whether an observed increase in a provider’s average quality is true quality improvement or whether it is a result of selecting healthier patients after reforms so that outcomes appear to have improved.
The overall objective of this study is to test whether the recently instituted reform requiring public reporting of quality of post-acute care in skilled nursing facilities (Nursing Home Compare) resulted in improved quality of care. Using data from the Minimum Data Set and Medicare claims, we measure changes in the post-acute care quality measures used in Nursing Home Compare and changes in re-hospitalization rates among post-acute care residents after Nursing Home Compare was released. We directly test two ways in which public reporting may improve quality: 1) improving quality within facilities and 2) increasing market share of high-quality facilities. In addition we test whether overall resident-level quality of care improves. To derive estimates of these changes in quality of care that are unbiased by patient selection, we use clinical data on all residents admitted to a nursing home for post-acute care and perform propensity score matching. We match residents in the pre-Nursing-Home-Compare period to residents in the post-Nursing-Home-Compare period to keep case-mix of post-acute care nursing home admissions constant and using this matched cohort, we test changes in resident-level care before and after Nursing Home Compare, changes in facility-level quality before and after Nursing Home Compare and changes in facility market share before and after Nursing Home Compare. Results will inform the policy debate on the effectiveness of public reporting and the mechanisms by which quality may be affected.