Headshot of Rachel Werner, MD, PhD

People who receive short-term treatment at nursing homes that specialize in post-acute care have lower rates of hospital readmission and death, according to a new study from the University of Pennsylvania Leonard Davis Institute.  

Patients at those specialized facilities had 7% lower death rates and 2% lower hospital readmission rates compared with patients receiving care at less specialized facilities.

Those positive outcomes came with tradeoffs, however.

Patients at those facilities had 10% longer stays, on average, or about three additional days of care per patient.

Longer stays also meant greater costs: Medicare bills averaged $1,200 more for patients at the more specialized facilities.

“Our results contribute to the current debate around reimagining the financing and delivery of long-term care in the wake of the COVID-19 pandemic,” noted the LDI study. “The role of specialization in healthcare has been widely discussed by economists and policymaker and is often proposed as a way to improve healthcare quality, decrease healthcare spending, and improve the value of care.”

But the study’s results only seem to complicate the discussion surrounding increasing post-acute care specialization at skilled nursing facilities. 

The authors — Zachary S. Templeton, associate fellow at LDI, and Rachel M. Werner, MD, PhD, executive director of LDI — noted the ambiguity their findings could cause for policymakers and for SNFs focused on both shorter, post-acute care and long-term care in a statement to McKnight’s Long-Term Care News.

“This raises questions about whether we should move more post-acute care to specialized nursing homes,” they said. “On one hand, patient outcomes would improve. On the other hand, it would cost Medicare more. In addition, because nursing homes rely on higher Medicare payment for post-acute care to subsidize Medicaid’s underpayment for long-term care, such a shift could harm nursing home finances and quality of long-term care.”

Relying on lower Medicaid payments for long-term care has made the future of some facilities — especially rural ones — increasingly uncertain.

Deep dive on post-acute care

Less uncertain is the correlation between increased specialization and the resulting increases in positive care outcomes, lengths of stay and Medicare costs.

A research update from LDI noted that as the study tracked SNFs increasing their post-acute specialization over time, patient outcomes, length of stay and costs increased simultaneously. This correlation supports the link between increasing specialization and getting the observed results. 

The in-depth study used Medicare data to track 12 million nursing home admissions between 2011 and 2018. 

Although the study noted the differences in outcomes between specialized and less-specialized care facilities, it couldn’t isolate the specific policies driving those differences.

“We are unable to determine the exact mechanisms by which more specialized nursing homes improve patient outcomes and increase utilization,” the study noted. “Using more granular data, future research could examine the adjustments facilities make as they become more specialized.”

The authors noted that further studies could focus on facilities’ building conditions, staffing levels, training programs and other internal processes to pinpoint specific causes.

At least one observed factor was linked to lowering the downsides to residents staying at specialized facilities.

“The increase in patient length of stay and spending among more specialized nursing homes is smaller among facilities that face less uncertainty in the demand for their PAC services,” the study said, “namely those owned by or located near hospitals.”

That greater access to pipelines of post-acute patients is just one of many, often-competing incentives for nursing homes, though.

“The overall welfare effects of nursing home specialization are ambiguous based on our results,” the study notes. “Specialization, therefore, is accompanied by a complex array of costs and benefits that policymakers must consider as they weigh alternatives to the current nursing home model.”