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Strategic Patient Discharge: The Case of Long-Term Care Hospitals

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  • Paul J. Eliason
  • Paul L. E. Grieco
  • Ryan C. McDevitt
  • James W. Roberts

Abstract

Medicare's prospective payment system for long-term acute-care hospitals (LTCHs) pro- vides modest reimbursements at the beginning of a patient's stay before jumping discontinuously to a large lump-sum payment after a pre-specified number of days. We show that LTCHs respond to financial incentives by disproportionately discharging patients after they cross the large-payment threshold, resulting in worse outcomes for patients. We find this occurs more often at for-profit facilities, facilities acquired by leading LTCH chains, and facilities co-located with other hospitals. Using a dynamic structural model, we evaluate counterfactual payment policies that would provide substantial savings for Medicare without adversely affecting patients.

Suggested Citation

  • Paul J. Eliason & Paul L. E. Grieco & Ryan C. McDevitt & James W. Roberts, 2016. "Strategic Patient Discharge: The Case of Long-Term Care Hospitals," NBER Working Papers 22598, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:22598
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Sam Watson’s journal round-up for 12th November 2018
      by Sam Watson in The Academic Health Economists' Blog on 2018-11-12 15:46:49

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    Cited by:

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    2. Martin B. Hackmann & R. Vincent Pohl & Nicolas R. Ziebarth, 2018. "Patient Versus Provider Incentives in Long Term Care," NBER Working Papers 25178, National Bureau of Economic Research, Inc.
    3. Liran Einav & Amy Finkelstein, 2018. "Moral Hazard in Health Insurance: What We Know and How We Know It," Journal of the European Economic Association, European Economic Association, vol. 16(4), pages 957-982.
    4. Moura, Ana, 2021. "Essays in health economics," Other publications TiSEM c93abd22-fa4a-42a5-b172-d, Tilburg University, School of Economics and Management.
    5. Chan, Marc K. & Zeng, Guohua, 2018. "Unintended consequences of supply-side cost control? Evidence from China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 61(C), pages 27-46.
    6. Maggie Shi, 2023. "Monitoring for Waste: Evidence from Medicare Audits," NBER Working Papers 31559, National Bureau of Economic Research, Inc.
    7. Mizuma, Kimiko & Amitani, Marie & Mizuma, Midori & Kawazu, Suguru & Sloan, Robert A. & Ibusuki, Rie & Takezaki, Toshiro & Owaki, Tetsuhiro, 2020. "Clarifying differences in viewpoints between multiple healthcare professionals during discharge planning assessments when discharging patients from a long-term care hospital to home," Evaluation and Program Planning, Elsevier, vol. 82(C).
    8. Moura, Ana, 2022. "Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal," Journal of Health Economics, Elsevier, vol. 84(C).
    9. Katalin Gaspar & Xander Koolman, 2022. "Provider responses to discontinuous tariffs: evidence from Dutch rehabilitation care," International Journal of Health Economics and Management, Springer, vol. 22(3), pages 333-354, September.
    10. De Fraja, Gianni & Berta, Paolo & Verzillo, Stefano, 2018. "Optimal Healthcare Contracts: Theory and Empirical Evidence from Italy," CEPR Discussion Papers 13357, C.E.P.R. Discussion Papers.
    11. Dillender, Marcus & Jinks, Lu & Lo Sasso, Anthony T., 2023. "When (and why) providers do not respond to changes in reimbursement rates," Journal of Public Economics, Elsevier, vol. 217(C).
    12. Liran Einav & Amy Finkelstein & Yunan Ji & Neale Mahoney, 2020. "Randomized trial shows healthcare payment reform has equal-sized spillover effects on patients not targeted by reform," Proceedings of the National Academy of Sciences, Proceedings of the National Academy of Sciences, vol. 117(32), pages 18939-18947, August.
    13. Manuel Adelino & Katharina Lewellen & W. Ben McCartney, 2022. "Hospital Financial Health and Clinical Choices: Evidence from the Financial Crisis," Management Science, INFORMS, vol. 68(3), pages 2098-2119, March.
    14. Liran Einav & Amy Finkelstein & Yunan Ji & Neale Mahoney, 2022. "Voluntary Regulation: Evidence from Medicare Payment Reform," The Quarterly Journal of Economics, Oxford University Press, vol. 137(1), pages 565-618.
    15. Clara Pott & Tom Stargardt & Udo Schneider & Simon Frey, 2021. "Do discontinuities in marginal reimbursement affect inpatient psychiatric care in Germany?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(1), pages 101-114, February.
    16. Liran Einav & Amy Finkelstein & Neale Mahoney, 2018. "Provider Incentives and Healthcare Costs: Evidence From Long‐Term Care Hospitals," Econometrica, Econometric Society, vol. 86(6), pages 2161-2219, November.
    17. Yang, Ou & Chan, Marc K. & Cheng, Terence C. & Yong, Jongsay, 2020. "Cream skimming: Theory and evidence from hospital transfers and capacity utilization," Journal of Economic Behavior & Organization, Elsevier, vol. 173(C), pages 68-87.

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    More about this item

    JEL classification:

    • D22 - Microeconomics - - Production and Organizations - - - Firm Behavior: Empirical Analysis
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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