Research using claims data from Medicare raises questions about the relative cost-effectiveness of inpatient care and post-acute-care in a skilled nursing facility.
New research on the cost-effectiveness of inpatient care at hospitals compared to skilled nursing facility (SNF) care is based on a technique used to compare hospital performance, the study's lead author says.
"When you compare hospitals, the big concern is [that] they treat different patients, which makes it very difficult to compare outcomes or how hospitals treat people. But now, we have a new way of comparing very similar patients who go to different hospitals," Joseph J. Doyle, Jr.
Doyle is a professor of applied economics at the Massachusetts Institute of Technology. He and colleagues at MIT and Vanderbilt University are using Medicare ambulance-service claims data to compare spending and other performance measures at hospitals.
The study Doyle published this month in the Journal of Health Economics, "Uncovering Waste in U.S. Healthcare: Evidence from Ambulance Referral Patterns," examined average 90-day spending on more than 1.5 million Medicare patients.
The research shows that hospitals that spend intensively on inpatient care and send patients home rather than to a SNF generate lower one-year mortality rates than hospitals that spend more intensively on post-acute-care at SNFs.
"We characterized the types of hospitals that get better outcomes. [They] tend to be more intense on the inpatient side. It doesn't necessarily have to be length of stay. Hospitals with better outcomes could be doing more inpatient procedures, for example," Doyle says.
Christopher Cheney is the senior clinical care editor at HealthLeaders.