To examine the effect of reductions in ospital‐ased () killed ursing acility () bed supply on the rate of rehospitalization of patients discharged to any from zip codes that lost beds.
We used edicare enrollment records, edicare hospital and claims, and nursing home inimum ataset assessments and characteristics () to examine nearly 10 million edicare fee‐for‐service hospital discharges to s between 1999 and 2006.
We calculated the number of and freestanding () beds within a 22 km radius from the centroid of all zip codes in which edicare eneficiaries reside in all years. We examined the relationship between and bed supply and the rehospitalization rates of the patients residing in corresponding zip codes in different years using zip code fixed effects and instrumental variable methods including extensive sensitivity analyses.
Our estimated coefficients suggest that closure of 882 homes during our study period resulted in 12,000–18,000 extra rehospitalizations within 30 days of discharge. The effect was largely concentrated among the most acutely ill, high‐need patients.
patient‐based prospective payment resulted in closure of higher cost facilities that had served most postacute patients. As other, less experienced s replaced facilities, they were less able to manage high acuity patients without rehospitalizing them.
