Shipping out instead of shaping up: rehospitalization from nursing homes as an unintended effect of public reporting

J Health Econ. 2013 Mar;32(2):341-52. doi: 10.1016/j.jhealeco.2012.11.008. Epub 2012 Dec 3.


Public reporting of health care quality has become a popular tool for incenting quality improvement. A fundamental question about public reporting is whether it causes providers to select healthier patients for treatment. In the nursing home post-acute setting, where patients must achieve a minimum length of stay to be included in quality measures, selection may take the form of discharge from the nursing home using rehospitalization, a particularly costly and undesirable outcome. We study the population of post-acute patients of skilled nursing facilities nationwide during 1999-2005 to assess whether selective rehospitalization occurred when public reporting was instituted in 2002, using multiple quasi-experimental designs to identify effects. We find that after public reporting was implemented, rehospitalizations before the length-of-stay cutoff increased. We conclude that nursing homes rehospitalize higher-risk post-acute patients to improve scores, providing evidence for selection behavior on the part of nursing home providers in the presence of public reporting.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Disclosure*
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Nursing Homes / organization & administration*
  • Nursing Homes / standards
  • Patient Readmission / economics
  • Patient Readmission / statistics & numerical data*
  • Patient Selection*
  • Quality Indicators, Health Care
  • United States