• Joshua M Liao, R Tamara Konetzka, and Rachel M Werner.
• Department of Medicine, University of Washington, Seattle, WA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: joshliao@uw.edu.
• Healthc (Amst). 2018 Sep 1; 6 (3): 175-179.

AbstractImproving 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.Copyright © 2018 Elsevier Inc. All rights reserved.

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