Table 1. SNF Characteristics Before and After Matching.
| SNFs | Standardized mean difference | Matched SNFs | Standardized mean difference | |||
|---|---|---|---|---|---|---|
| BPCI (n=467) | Non-BPCI (n=12 670) | BPCI (n=448) | Non-BPCI (control) (n=1958) | |||
| SNF characteristics | ||||||
| No. of LEJR admissions, preintervention period to 9 mo | 14.57 | 7.7 | 0.19 | 10.8 | 9.9 | 0.06 |
| For profit, % | 79.2 | 69.2 | 0.21 | 79.0 | 75.0 | 0.09 |
| Nonprofit, % | 18.4 | 24.8 | 0.15 | 18.5 | 20.6 | 0.05 |
| Public, % | 2.4 | 5.9 | 0.15 | 2.5 | 4.3 | 0.10 |
| Urban, %a | 85.4 | 71.6 | 0.30 | 85.0 | 85.1 | 0.00 |
| No. of federally certified beds | 115.1 | 110 | 0.09 | 115 | 117 | 0.04 |
| Part of a chain, % | 85.7 | 56.6 | 0.58 | 85 | 82 | 0.08 |
| Hospital-based, % | 1.1 | 4.1 | 0.17 | 0.9 | 1.0 | 0.01 |
| Region, % | ||||||
| Northeast | 25.1 | 17.2 | 0.22 | 25 | 22 | 0.08 |
| Midwest | 31.5 | 32.7 | 0.02 | 32 | 34 | 0.05 |
| South | 26.8 | 35.8 | 0.20 | 26 | 28 | 0.04 |
| West | 16.1 | 14.3 | 0.06 | 16 | 15 | 0.03 |
| Overall Medicare star ratingb | 3.5 | 3.3 | 0.11 | 3.5 | 3.4 | 0.04 |
| Monthly trends in patient-level outcomesc | ||||||
| SNF days | −0.023 | −0.01 | 0.07 | −0.02 | −0.02 | 0.02 |
| Home health agency visits | 0.0003 | −0.002 | 0.05 | −0.0004 | −0.0003 | 0.00 |
| Hospital readmission rate, % | −0.001 | −0.13 | 0.02 | −0.13 | −0.13 | 0.00 |
| Mortality, % | −0.0002 | −0.03 | 0.03 | −0.02 | −0.02 | 0.02 |
| Institutional spending, $ | −8.64 | 1.35 | 0.08 | −7.61 | −3.80 | 0.03 |
| County-level characteristicsd | ||||||
| Population aged 65 and older | 105 778 | 95 806 | 0.05 | 104 589 | 94 629 | 0.07 |
| Median household income, $ | 53 814 | 51 539 | 0.17 | 53 805 | 53 226 | 0.04 |
| % Medicare Advantage penetration | 29.22 | 25.9 | 0.24 | 29.3 | 30.2 | 0.07 |
| SNF beds per 10 000 | 416.6 | 467.6 | 0.21 | 420.1 | 428.1 | 0.04 |
| No. of inpatient rehabilitation facilitiese | 0.53 | 0.46 | 0.07 | 0.54 | 0.46 | 0.07 |
| Mean SNF market share in countyf | 0.16 | 0.21 | 0.20 | 0.15 | 0.14 | 0.02 |
| Herfindahl-Hirshman Index for SNFsg | 0.08 | 0.08 | 0.06 | 0.08 | 0.07 | 0.06 |
Abbreviations: BPCI, Bundled Payment for Care Improvement; LEJR, lower extremity joint replacement; SNF, skilled nursing facility.
Urban location defined using the Health Resources and Service Administration rural-urban commuting area code database (http://depts.washington.edu/uwruca/index.php). Urban was defined as a patient residing in a metropolitan ZIP code.20
Medicare star ratings range from 1 (much below average) to 5 (much above average). This score is a composite ranking of individual SNFs that incorporates multiple measures of SNF quality, staffing, and health inspection performance.25
Measured using claims data from the baseline period (January 2013-September 2013). To improve stability of estimates, trends were estimated based on all Medicare admissions to each SNF. All outcomes were measured in the period of BPCI model 3 bundles (ie, 90-day post SNF admission).
Assessed in 2013 using the Area Health Resource File, except for SNF market share (see footnote e).
Inpatient rehabilitation facilities are a separate type of facility from SNFs that provide postacute care for patients requiring higher-intensity therapy. They can be competitors to SNFs for market share for patients undergoing LEJR.
Indicates the proportion of all Medicare SNF admissions in a county that occur at a single SNF. The mean county-level SNF market share is the average market share of all SNFs in that county.
This index is commonly used to measure market concentration, which was defined using the sum of squares of the market shares in the county.13