Exhibit 4.

Unadjusted percent of patients in skilled nursing facilities (SNFs) at risk for a given outcome who experienced it, by whether or not they had any physician or advanced practitioner visit

SOURCE Authors’ analysis of data from the Minimum Data Set, version 3.0, and Medicare Part A claims data from the Medicare Provider Analysis and Review files for 2,392,753 SNF stays by fee-for-service beneficiaries with both Part A and Part B coverage in the period January 2012–October 2014. NOTES “No visit” refers to the stays with no physician or advanced practitioner visit billed for between admission and discharge from the SNF. A visit was defined as any submitted claims for SNF services or office visits using the Healthcare Common Procedure Coding System codes listed in the text from the Medicare Carrier file. A successful discharge from a SNF to the community is a discharge from the SNF within 100 days of admission that is not followed by death, rehospitalization, or readmission to the SNF within thirty days of the discharge. The categories are not mutually exclusive. All comparisons between the two groups (patients with and without any physician or advanced practitioner visit) were significantly different (p < 0:001).