Are Medicare's Nursing Home Compare Ratings Accurate Predictors of 90-Day Complications, Readmission, and Bundle Cost for Patients Undergoing Primary Total Joint Arthroplasty?

Daniel J. Snyder, Thomas R. Kroshus, Aakash Keswani, Evan B. Garden, Karl Koenig, Kevin Bozic, David S. Jevsevar, Jashvant Poeran, Calin S. Moucha

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Nursing Home Compare (NHC) ratings, created and maintained by Medicare, are used by both hospitals and consumers to aid in the skilled nursing facility (SNF) selection process. To date, no studies have linked NHC ratings to actual episode-based outcomes. The purpose of this study was to evaluate whether NHC ratings are valid predictors of 90-day complications, readmission, and bundle costs for patients discharged to an SNF after primary total joint arthroplasty (TJA). Methods: All SNF-discharged primary TJA cases in 2017 at a multihospital academic health system were queried. Demographic, psychosocial, and clinical variables were manually extracted from the health record. Medicare NHC ratings were then collected for each SNF. For patients in the Medicare bundle, postacute and total bundle cost was extracted from claims. Results: Four hundred eighty-eight patients were discharged to a total of 105 unique SNFs. In multivariate analysis, overall NHC rating was not predictive of 90-day readmission/major complications, >75th percentile postacute cost, or 90-day bundle cost exceeding the target price. SNF health inspection and quality measure ratings were also not predictive of 90-day readmission/major complications or bundle performance. A higher SNF staffing rating was independently associated with a decreased odds for >75th percentile 90-day postacute spend (odds ratio, 0.58; P =.01) and a 90-day bundle cost exceeding the target price (odds ratio = 0.69; P =.02) but was similarly not predictive of 90-day readmission/complications. Conclusion: Results of our study suggest that Medicare's NHC tool is not a useful predictor of 90-day costs, complications, or readmissions for SNFs within our health system.

Original languageEnglish (US)
Pages (from-to)613-618
Number of pages6
JournalJournal of Arthroplasty
Volume34
Issue number4
DOIs
StatePublished - Apr 1 2019

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Skilled Nursing Facilities
Medicare
Nursing Homes
Arthroplasty
Joints
Costs and Cost Analysis
Health
Odds Ratio
Multivariate Analysis
Demography

Keywords

  • episode-based outcomes
  • nursing home compare
  • postacute care
  • skilled nursing facility
  • total joint arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Are Medicare's Nursing Home Compare Ratings Accurate Predictors of 90-Day Complications, Readmission, and Bundle Cost for Patients Undergoing Primary Total Joint Arthroplasty? / Snyder, Daniel J.; Kroshus, Thomas R.; Keswani, Aakash; Garden, Evan B.; Koenig, Karl; Bozic, Kevin; Jevsevar, David S.; Poeran, Jashvant; Moucha, Calin S.

In: Journal of Arthroplasty, Vol. 34, No. 4, 01.04.2019, p. 613-618.

Research output: Contribution to journalArticle

Snyder, Daniel J. ; Kroshus, Thomas R. ; Keswani, Aakash ; Garden, Evan B. ; Koenig, Karl ; Bozic, Kevin ; Jevsevar, David S. ; Poeran, Jashvant ; Moucha, Calin S. / Are Medicare's Nursing Home Compare Ratings Accurate Predictors of 90-Day Complications, Readmission, and Bundle Cost for Patients Undergoing Primary Total Joint Arthroplasty?. In: Journal of Arthroplasty. 2019 ; Vol. 34, No. 4. pp. 613-618.
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abstract = "Background: Nursing Home Compare (NHC) ratings, created and maintained by Medicare, are used by both hospitals and consumers to aid in the skilled nursing facility (SNF) selection process. To date, no studies have linked NHC ratings to actual episode-based outcomes. The purpose of this study was to evaluate whether NHC ratings are valid predictors of 90-day complications, readmission, and bundle costs for patients discharged to an SNF after primary total joint arthroplasty (TJA). Methods: All SNF-discharged primary TJA cases in 2017 at a multihospital academic health system were queried. Demographic, psychosocial, and clinical variables were manually extracted from the health record. Medicare NHC ratings were then collected for each SNF. For patients in the Medicare bundle, postacute and total bundle cost was extracted from claims. Results: Four hundred eighty-eight patients were discharged to a total of 105 unique SNFs. In multivariate analysis, overall NHC rating was not predictive of 90-day readmission/major complications, >75th percentile postacute cost, or 90-day bundle cost exceeding the target price. SNF health inspection and quality measure ratings were also not predictive of 90-day readmission/major complications or bundle performance. A higher SNF staffing rating was independently associated with a decreased odds for >75th percentile 90-day postacute spend (odds ratio, 0.58; P =.01) and a 90-day bundle cost exceeding the target price (odds ratio = 0.69; P =.02) but was similarly not predictive of 90-day readmission/complications. Conclusion: Results of our study suggest that Medicare's NHC tool is not a useful predictor of 90-day costs, complications, or readmissions for SNFs within our health system.",
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AU - Kroshus, Thomas R.

AU - Keswani, Aakash

AU - Garden, Evan B.

AU - Koenig, Karl

AU - Bozic, Kevin

AU - Jevsevar, David S.

AU - Poeran, Jashvant

AU - Moucha, Calin S.

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AB - Background: Nursing Home Compare (NHC) ratings, created and maintained by Medicare, are used by both hospitals and consumers to aid in the skilled nursing facility (SNF) selection process. To date, no studies have linked NHC ratings to actual episode-based outcomes. The purpose of this study was to evaluate whether NHC ratings are valid predictors of 90-day complications, readmission, and bundle costs for patients discharged to an SNF after primary total joint arthroplasty (TJA). Methods: All SNF-discharged primary TJA cases in 2017 at a multihospital academic health system were queried. Demographic, psychosocial, and clinical variables were manually extracted from the health record. Medicare NHC ratings were then collected for each SNF. For patients in the Medicare bundle, postacute and total bundle cost was extracted from claims. Results: Four hundred eighty-eight patients were discharged to a total of 105 unique SNFs. In multivariate analysis, overall NHC rating was not predictive of 90-day readmission/major complications, >75th percentile postacute cost, or 90-day bundle cost exceeding the target price. SNF health inspection and quality measure ratings were also not predictive of 90-day readmission/major complications or bundle performance. A higher SNF staffing rating was independently associated with a decreased odds for >75th percentile 90-day postacute spend (odds ratio, 0.58; P =.01) and a 90-day bundle cost exceeding the target price (odds ratio = 0.69; P =.02) but was similarly not predictive of 90-day readmission/complications. Conclusion: Results of our study suggest that Medicare's NHC tool is not a useful predictor of 90-day costs, complications, or readmissions for SNFs within our health system.

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