Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Black and Hispanic Patients

• Published in: The journals of gerontology. Series A, Biological sciences and medical sciences Biological sciences and medical sciences, 2019-04, Vol.74 (5), p.689-697
• Main Authors: Rivera-Hernandez, Maricruz, Rahman, Momotazur, Mukamel, Dana B, Mor, Vincent, Trivedi, Amal N
• Format: Article
• Language: English
• Subjects: Aged; Black or African American - statistics & numerical data; Cross-Sectional Studies; Female; Health care access; Healthcare Disparities - statistics & numerical data; Hispanic or Latino - statistics & numerical data; Humans; Male; Medicare; Minority & ethnic groups; Nursing; Nursing homes; Quality of care; Quality of Health Care; Skilled Nursing Facilities - standards; Subacute care; Subacute Care - standards; The Journal of Gerontology: Medical Sciences; United States
• ISSN: 1079-5006; 1758-535X
• DOI: 10.1093/gerona/gly089

Abstract Background Understanding and addressing racial and ethnic disparities in the quality of post-acute care in skilled nursing facilities is an important health policy issue, particularly as the Medicare program initiates value-based payments for these institutions. Methods Our final cohort included 649,187 Medicare beneficiaries in either the fee-for-service or Medicare Advantage programs, who were 65 and older and were admitted to a skilled nursing facility following an acute hospital stay, from 8,375 skilled nursing facilities. We examined the quality of care in skilled nursing facilities that disproportionately serve minority patients compared to non-Hispanic whites. Three measures, all calculated at the level of the facility, were used to assess quality of care in skilled nursing facilities: (a) 30-day rehospitalization rate; (b) successful discharge from the facility to the community; and (c) Medicare five-star quality ratings. Results We found that African American post-acute patients are highly concentrated in a small number of institutions, with 28% of facilities accounting for 80% of all post-acute admissions for African American patients. Similarly, just 20% of facilities accounted for 80% of all admissions for Hispanics. Skilled nursing facilities with higher fractions of African American patients had worse performance for three publicly reported quality measures: rehospitalization, successful discharge to the community, and the star rating indicator. Conclusions Efforts to address disparities should focus attention on institutions that disproportionately serve minority patients and monitor unintended consequences of value-based payments to skilled nursing facilities.