Hospital and Skilled Nursing Facility Networks: Informal Relationships and Their Role in the Placement of Traditional Medicare Beneficiaries With Serious Mental Illness.

Abstract

Objective: To examine the role of hospitals' high-volume preferred provider networks in skilled nursing facility (SNF) placement for traditional Medicare beneficiaries with serious mental illnesses (SMI).

Study setting and design: We describe the differential effect of preferred provider networks on the location of observed SNF admission (i.e., placement) for patients with and without SMI using ordinary least squares (OLS) regression and conditional logistic regression. We also consider the moderating effect of having a co-occurring condition targeted by value-based payment programs.

Data sources and analytic sample: A 100% sample of Medicare Provider Analysis and Review (MedPAR) files used to identify acute care hospital-to-SNF transitions between 2017 and 2019.

Principal findings: Overall, patients with SMI have a lower probability of being admitted to a referring hospital's preferred SNF partner (48.0% vs. 52.4%; p < 0.001). We find evidence that incentives introduced through the hospital readmission reduction program (HRRP) moderate this observed relationship, where, relative to their SMI counterparts, individuals with SMI and an HRRP condition have a greater probability of being admitted to a preferred SNF (47.6% vs. 51.1%; p < 0.001). We find similar effects using conditional logistic regression, where preferredness is significantly more predictive of admission to the most proximate SNF for patients without SMI versus those with SMI. This effect is again moderated by the presence of a co-occurring HRRP condition.

Conclusions: Volume-driven preferred partner relationships differentially impact referral patterns for traditional Medicare patients with SMI. Our findings suggest that patients with complex mental and behavioral health conditions may not benefit equally from more targeted investments in transitional care practices that are made in response to these partnerships. Yet our findings are also suggestive of opportunities to leverage existing hospital-SNF relational dynamics to improve the quality of care for a broader group of medically and socially complex patients.