Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Dec;45(6 Pt 2):1981-2006.
doi: 10.1111/j.1475-6773.2010.01190.x. Epub 2010 Oct 28.

Effects of competition on the cost and quality of inpatient rehabilitation care under prospective payment

Carrie Hoverman Colla  1 , José J Escarce, Melinda Beeuwkes Buntin, Neeraj Sood
Affiliations

Effects of competition on the cost and quality of inpatient rehabilitation care under prospective payment

Carrie Hoverman Colla et al. Health Serv Res. 2010 Dec.

Abstract

Objective: To determine the effect of competition in postacute care (PAC) markets on resource intensity and outcomes of care in inpatient rehabilitation facilities (IRFs) after prospective payment was implemented.

Data sources: Medicare claims, Provider of Services file, Enrollment file, Area Resource file, Minimum Data Set.

Study design: We created an exogenous measure of competition based on patient travel distances and used instrumental variables models to estimate the effect of competition on inpatient rehabilitation costs, length of stay, and death or institutionalization.

Data extraction methods: A file was constructed linking data for Medicare patients discharged from acute care between 2002 and 2003 and admitted to an IRF with a diagnosis of hip fracture or stroke.

Principal findings: Competition had different effects on treatment intensity and outcomes for hip fracture and stroke patients. In the treatment of hip fracture, competition increased costs and length of stay, while increasing rates of death or institutionalization. In the treatment of stroke, competition decreased costs and length of stay and produced inferior outcomes.

Conclusions: The effects of competition in PAC markets may vary by condition. It is important to study the effects of competition by diagnostic condition and to study the effects across populations that vary in severity. Our finding that higher competition under prospective payment led to worse IRF outcomes raises concerns and calls for additional research.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Number of Complications and Comorbidities by Competition Quartiles
Figure 2
Figure 2
Study Outcomes by Competition Quartiles
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Angelelli J, Gifford D, Intrator O, Gozalo P, Laliberte L, Mor V. Access to Postacute Nursing Home Care before and after the Balanced Budget Act. Health Affairs (Millwood) 2002;21(5):254–64. - PubMed
    1. Angrist JD, Imbens GW. Two-Stage Least Squares Estimation of Average Causal Effects in Models with Variable Treatment Intensity. Journal of the American Statistical Association. 1995;90(430):431–42.
    1. Bundorf MK, Schulman KA, Stafford JA, Gaskin D, Jollis JG, Escarce JJ. Impact of Managed Care on the Treatment, Costs, and Outcomes of Fee-For-Service Medicare Patients with Acute Myocardial Infarction. Health Services Research. 2004;39(1):131–52. - PMC - PubMed
    1. Buntin MB, Colla CH, Escarce JJ. Effects of Payment Changes on Trends in Access to Post-Acute Care. Health Services Research. 2009;44(4):1188–210. - PMC - PubMed
    1. Buntin MB, Garten AD, Paddock S, Saliba D, Totten M, Escarce JJ. How Much Is Postacute Care Use Affected by Its Availability? Health Services Research. 2005;40(2):413–34. - PMC - PubMed

Publication types

MeSH terms