Department of Medicine, University of Washington, Seattle, WA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
Department of Public Health Services, University of Chicago, Chicago, IL, United States.
Healthc (Amst). 2018 Sep;6(3):175-179. doi: 10.1016/j.hjdsi.2018.05.001. Epub 2018 May 7.
Improving the value of post-acute care at skilled nursing facilities (SNFs) has become a Medicare policy priority. Anecdotally, hospitals have responded by formally acquiring or pursuing tighter informal connections with SNFs. We evaluated the trend in connections between US acute care hospitals and Medicare-certified SNFs between 2000 and 2013 using vertical integration and two novel network-based measures (number of SNF partners, and discharge concentration). Among 4441 hospitals and 17,215 SNFs, hospitals with weaker connections with SNFs were more often non-profit, major teaching hospitals with a larger number of discharges and beds. We found an apparent weakening of hospital-SNF connections over time for all three measures. Over one-third (39%) of hospitals were vertically integrated in 2000 compared to 8.2% in 2013. The number of SNF partners increased between 2000 and 2013, while hospitals' discharge concentration declined steadily. Additional work is needed to understand the implications of these trends.
提高熟练护理设施（SNF）的后期护理价值已成为医疗保险政策的重点。据传闻，医院已通过正式收购或建立更紧密的非正式联系来对此做出回应。我们使用垂直整合和两种新颖的基于网络的措施（SNF 合作伙伴的数量和出院集中度），评估了 2000 年至 2013 年间美国急性护理医院与医疗保险认证的 SNF 之间的联系趋势。在 4441 家医院和 17215 家 SNF 中，与 SNF 联系较弱的医院往往是非营利性、主要教学医院，其出院人数和床位较多。我们发现，所有三种措施的医院-SNF 联系都随着时间的推移而明显减弱。2000 年，有三分之一以上（39%）的医院实现了垂直整合，而 2013 年仅为 8.2%。2000 年至 2013 年间，SNF 合作伙伴的数量增加，而医院的出院集中度则稳步下降。需要进一步研究这些趋势的影响。
