AHRQ Grant HS021877: Related Publication Summaries

Improving Nursing Home Compare for Dually Eligible Consumers

1. "Shipping out instead of shaping up: Rehospitalization from nursing homes as an unintended effect of public reporting."

Konetzka RT, Polsky D, Werner RM.
Journal of Health Economics 2013 Mar; 32(2):341-52.
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To assess whether selective rehospitalization of nursing home residents occurred when public reports were instituted in 2002, the researchers examined data on post-acute patients of skilled nursing facilities nationwide during 1999-2005. They concluded 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.

2. "Nursing home 5-star rating system exacerbates disparities in quality, by payer source."

Tamara Konetzka R, Grabowski DC, Perraillon MC, Werner RM.
Health Affairs 2015 May; 34(5):819-27.
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The authors assessed the extent to which dual eligible (those enrolled in both Medicare and Medicaid) and non-dual eligibles avoided the lowest-rated nursing homes and chose the highest-rated homes once the five-star rating system began, in late 2008. They found that both populations resided in better quality homes over time, but that by 2010 the increased likelihood of choosing the highest-rated homes was substantially smaller for dual eligibles than for non-dual eligibles. This is likely due in part to higher-rated homes being located in more affluent areas. They suggest that increases in Medicaid payment rates for nursing home services may be the only long-term solution.

3. "Understanding why patients with COPD get readmitted: A large national study to delineate the Medicare population for the readmissions penalty expansion."

Shah T, Churpek MM, Coca Perraillon M, Konetzka RT.
Chest 2015 May;147(5):1219-26.
PUBMED link:

This study examined Medicare claims data from 2006 to 2010 in seven States with an index admission for chronic obstructive pulmonary disease (COPD). Over the study period, there were 26,798,404 inpatient admissions, of which 3.5% were index COPD admissions. At 30 days, 20.2% were readmitted to the hospital. Patients discharged home without home care were more likely to be readmitted for COPD than patients discharged to post-acute care, and were more likely to be dually enrolled in Medicare and Medicaid. This suggests that hospitals may be penalized under CMS’ Hospital Readmissions Reduction Program as a result of treating a poorer, sicker mix of patients.

4. "The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment."

Konetzka RT, Brauner DJ, Shega J, Werner RM.
Journal of the American Geriatric Society 2014 Mar;62(3):454-61.
PUBMED link:

This study compared use of physical restraints for nursing home (NH) residents with severe cognitive impairment in 4,258 nursing homes in six States from 1999 to 2008 among NHs subject to public reporting of physical restraints and those without reporting requirements. Physical restraint use declined significantly during the study period, but was larger in NHs that were subject to reporting of restraints. Correspondingly, antipsychotic use in the same residents increased more in NHs subject to public reporting, which may have been an unintended consequence of public reporting of physical restraint use.


Page last reviewed December 2017
Page originally created January 2016
Internet Citation: AHRQ Grant HS021877: Related Publication Summaries. Content last reviewed December 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/sciencepubreport/hs021877.html