Integration and Task Allocation: Evidence from Patient Care

David, Guy; Rawley, Evan; Polsky, Daniel

doi:10.2139/ssrn.1880656

Cited by 17 publications

(33 citation statements)

References 21 publications

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“…The overall increases in SNF length of stay that we observe among vertically integrated hospital-SNF pairs is the combined effect of a small decrease in hospital length of stay and a larger increase in SNF length of stay. The decrease in hospital length of stay provides some evidence that vertical integration has induced more efficient task allocation between hospitals and SNFs ( David et al, 2013 ). That is, hospitals shift the management of patients from hospitals to SNFs sooner (where the production of care is less expensive), and SNFs have incentive to accept patients quicker and sicker because they can share in the joint revenue from the hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…Admitting a patient earlier to these types of PAC erodes margins downstream, as it is costlier to care for patients who are still in intensive stages of recovery. This creates conflicting incentives for hospitals and HHAs, both of which want to shorten length of stay, resulting in an inherent conflict regarding the optimal timing of transition across settings ( David et al, 2013 ).…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…Two prior papers have examined the effect of vertical integration on practice patterns in post-acute care using data on integration of hospitals with home health agencies and skilled nursing facilities. David et al (2013) conceptualize vertical integration as a solution to an incomplete contracting problem, whereby integration allows tasks that are substitutable across settings to be more efficiently allocated to the lower-cost setting (the post-acute care or PAC setting). They find that hospitals that are vertically integrated tend to discharge patients to post-acute care quicker and sicker, yet health outcomes are the same or better, suggesting that vertical integration reduces coordination problems ( David et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

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The effect of integration of hospitals and post-acute care providers on Medicare payment and patient outcomes

Konetzka

Stuart

Werner

2018

Journal of Health Economics

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In this paper we examine empirically the effect of integration on Medicare payment and rehospitalization. We use 2005–2013 data on Medicare beneficiaries receiving post-acute care (PAC) in the U.S. to examine integration between hospitals and the two most common post-acute care settings: skilled nursing facilities (SNFs) and home health agencies (HHA), using two measures of integration—formal vertical integration and informal integration representing preferential relationships between providers without formal relationships. Our identification strategy is twofold. First, we use longitudinal models with a fixed effect for each hospital-PAC pair in a market to test how changes in integration impact patient outcomes. Second, we use an instrumental variable approach to account for patient selection into integrated providers. We find that vertical integration between hospitals and SNFs increases Medicare payments and reduces rehospitalization rates. However, vertical integration between hospitals and HHAs has little effect, nor does informal integration between hospitals and either PAC setting.

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Section: Discussionmentioning

confidence: 99%

Section: Conceptual Frameworkmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of integration of hospitals and post-acute care providers on Medicare payment and patient outcomes

Konetzka

Stuart

Werner

2018

Journal of Health Economics

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“…To the extent that the vertical integration of hospital‐based facilities improves coordination of care, the balance of freestanding and hospital‐based facilities may have important implications for health care quality and costs. For example, recent research shows that vertical integration of home health agencies allows for more efficient provision of care with no adverse impacts on patient outcomes (David, Rawley, and Polsky ). More research is needed on the broader impacts of vertical integration, but this evidence suggests that the closure of hospital‐based post‐acute facilities may lead to lower levels of efficiency.…”

Section: Discussionmentioning

confidence: 99%

Medicare Payment Reform and Provider Entry and Exit in the Post‐Acute Care Market

Huckfeldt

Sood

Romley

et al. 2013

Health Services Research

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Objective. To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources. Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design. We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods. We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Principal Findings. Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Conclusions. Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms.Provisions in the Affordable Care Act represent an important restructuring of payment for health care providers. Accountable care organizations and "bundled" payments for acute and post-acute care create incentives for coordinating and reorganizing the delivery of health care by changing provider payment for an episode of care, where care during an episode can be provided

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“…We then use Coarsened Exact Matching (Iacus, et. al., 2011;David, et. al., 2013) and propensity score matching (Rosenbaum and Rubin, 1983) to identify managers who are identical to the managers who transition based on all the observable characteristics of the individuals, their funds, and firms that might plausibly predict a transition.…”

Section: Data and Empirical Methodsmentioning

confidence: 99%

Learning on the Job? Employee Mobility in the Asset Management Industry

2016

Self Cite

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We present a new mechanism by which prior employment can influence transitions to other firms. We propose that some employees divert effort toward unproductive activities to learn about their own fitness for alternative employment. Based on the results of this costly learning experience, or "experiment," some employees will transition into other firms or launch their own ventures, while others will remain at the incumbent firm. We develop a theoretical model to explicate these propositions, and test them using four datasets from the mutual fund and hedge fund industries. We find evidence that managers who engage in excessive risk-taking at mutual funds are subsequently more likely to join or start hedge funds, even though there is little evidence that this risk-taking is intended to signal quality to outside observers. Taken together, our findings suggest that learning about one's own fitness for alternative employment, through experimentation on the job, is an important mechanism for enabling employee mobility.

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Integration and Task Allocation: Evidence from Patient Care

Cited by 17 publications

References 21 publications

The effect of integration of hospitals and post-acute care providers on Medicare payment and patient outcomes

The effect of integration of hospitals and post-acute care providers on Medicare payment and patient outcomes

Medicare Payment Reform and Provider Entry and Exit in the Post‐Acute Care Market

Learning on the Job? Employee Mobility in the Asset Management Industry

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