Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Jillian B. Harvey

Second Advisor

Kit N. Simpson

Third Advisor

Stephanie Corbett

Fourth Advisor

James S Zoller


This paper is a retrospective analysis of the pre- and post-implementation of a CMS quality measure designed for its Nursing Home Compare Five-Star Quality Rating System. The measure, Percentage of short-stay residents who have had an outpatient emergency room visit (Medicare claims-based) introduced in 2016, was added due to the increasing rates of resident transfers to acute-care facilities. The skilled nursing facility’s performance outcomes of this measure will determine payment by CMS as part of the new skilled nursing facility value-based purchasing program (SNF VBP), which is set to be implemented in 2019. Methods: Information found in the Skilled Nursing Facility records within the Medicare 5% national sample data set comprised the data for the study. Time frames for the applicable data were from January through December of 2015 and January through December 2016. Data was selected for all nursing home residents with a nursing home stay of 30 days or less (short-stay residents). Results: A total of 126,098 patients were examined within the dataset, 63,546 discharges were included for 2015 and 62,552 discharges for 2016. A total of 39,275 patients were transferred from a SNF to the hospital with 20,248 (31.86%) transferred in the pre-quality measure implementation year, and 19,027 (30.42%) in the post quality improvement year. The percent of patients who were transferred to a hospital declined from 31.9% in 2015 to 30.4% in 2016. Conclusion: The rate of transfer of short-stay SNF residents was reduced in the post-quality measure implementation year 2016. It is unknown if the reduction in transfers was a direct result of the implementation of the quality measure or due to other causes. Answering this question warrants the need for future research.


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