Preferred Provider Relationships Between Medicare Advantage Plans and Skilled Nursing Facilities Reduce Switching Out of Plans: An Observational Analysis

Abstract

Unlike traditional Medicare, Medicare Advantage (MA) plans contract with specific skilled nursing facilities (SNFs). Patients treated in an MA plan’s preferred SNF may benefit from enhanced coordination and have a lower likelihood of switching out of their plan. Using 2011-2014 Medicare enrollment data, the Medicare Healthcare Effectiveness Data and Information Set, and the Minimum Data Set, we examined Medicare enrollees who were newly admitted to SNFs in 2012-2013. We used the Centers for Medicare & Medicaid Services star rating to distinguish between MA plans and show how SNF concentration experienced by patients varies between patients in plans with different star ratings. We found that highly rated MA plans steer their patients to a smaller number of SNFs, and these patients are less likely to switch out of their plans. Strengthening the MA plan–SNF relationship may lower disenrollment rates for SNF beneficiaries, imparting benefits to both patients and payers.

Impact of skilled nursing facility quality on postoperative outcomes after pancreatic surgery

“…The Nursing Home Compare dataset has been used to examine the effect of SNF quality on health outcomes. 15,16,18,19 Patients who were enrolled in Medicare Part A and Part B, had no additional payments from a health maintenance organization (HMO), and had no record of payment made by a primary payer were selected. Patients who were admitted from an outside hospital, an SNF, or another health care facility at the time of index admission were excluded in order to obtain a homogenous group and to limit confounding.…”

“…Compared with patients who were discharged to home, patients who were discharged to an SNF were somewhat older (median age: 72 years [IQR 68-76] vs 76 years [IQR 71-80]), more likely to be female (44.4% vs 56.8%), and had a greater preoperative Charlson comorbidity score (median score: 3 [IQR 2-8] vs 4 [IQR 2-8]) (all P < .001). Patients discharged to a SNF generally had a greater LOS (median days 8 [IQR 6-12]) vs 12 [IQR [8][9][10][11][12][13][14][15][16][17][18]) and were more likely to have experienced a complication during the index hospital stay. Specifically, patients discharged to a SNF had a greater incidence of pulmonary failure, pneumonia, myocardial infarction, DVT/PE, acute renal failure, hemorrhage, and surgical-site infection during their index admission (all P < .001) ( Table 2 ).…”

“…The median number of nurse and physical therapy hours per resident day were 0.78 (IQR 0.55-1.13) and 0.15 (IQR 0.09-0.23), respectively ( [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]; P = .380). Although LOS was comparable among the SNFs of different quality star ratings, the incidence of 30-day hospital readmission was greatest among patients who were discharged to a below-average SNF ( Fig 1 , below average, N = 217, 44.3%, average N = 110, 37.4%, above average N = 517, 35.3%; P = .002).…”