https://links.lww.com/MLR/C569

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APPENDIX

Figure 1A: Flow chart depicting the selection of the analytic sample

Short-term inpatient beneficiaries who underwent joint replacement

01/01/2013-12/31/2017 (n=27,373,455)

Beneficiaries who discharged to SNF within 30-day of hospital discharge, were covered with Medicare Fee- for-Services, and enrolled in both Part A and Part B

01/01/2013-06/30/2017 (n= 582,766)

330 SNFs in the persistent- participating group

(n=26,215)

146 SNFs in the drop-out group (n=10,460)

14,028 SNFs in the nonparticipating group

(n= 547,661)

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Categorizations of non-White-serving SNFs and Medicaid-dependent SNFs

To define the binary indicator for SNFs disproportionately serving Black, Hispanic, Asian, and other racial/ethnic minority residents, we extracted the Research Triangle Institute race code^27,28 from the MBSF-Base Segment to determine if the beneficiary was a Black, Hispanic, Asian, and other racial/ethnic minority. The information was linked to the MDS 3.0 by a Medicare crosswalk file to calculate proportions of residents who were Black, Hispanic, Asian, and other racial/ethnic minority for each SNF. For each quarter, we categorized facilities in the highest quartile of proportions of Black, Hispanic, Asian, and other racial/ethnic minority residents as non-White-serving SNFs, and the other 75% of SNFs were classified as White- serving SNFs for the persistent-participating group, drop-out group, and eligible nonparticipating group, respectively. Similarly, to determine if the SNF was Medicaid-dependent, we first explored the state-reported dual status variable from the MBSF-Base Segment to identify whether the beneficiary was enrolled in (full/partial) Medicaid (i.e., a proxy for the socioeconomic status) or had Medicare coverage only.²⁹ We then merged the data with the MDS 3.0 to compute percentages of Medicaid residents of the facility. SNFs in the highest quartile of shares of Medicaid patients were categorized as Medicaid-dependent SNFs, and the remaining SNFs were considered as non-Medicaid-dependent SNFs for each BPCI SNF group in each quarter.

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Sensitivity Analyses: Propensity Score Approach

To date, there is no propensity score (PS) approach that is particularly designed for a longitudinal analysis with multiple treatments (>=2 treatment groups, like persistent-participating SNFs and drop-out SNFs in our study). Therefore, we performed two separate PS analyses for persistent-enrollment SNFs and drop-out SNFs, respectively. Take the persistent-participating group as an example. First, we calculated SNF-level propensity scores by fitting a logistic regression model of the probability of participating in BPCI Model 3 as a function of SNF (i.e., number of beds, nursing hours per resident day for registered nurses, licensed practical nurses, and certified nursing assistants, number of deficiency citations, ownership[for-profit, nonprofit, and government-owned], chain affiliation [yes/no], and hospital-based[yes/no]) and market (population aged 65 and older, MA penetration, SNF beds per 10,000 residents, ACO penetration, urban location [yes/no], a measure of market competition) characteristics, and patient outcomes in pre-intervention period (i.e., 2013Q1-2013Q3). Using the propensity scores, we matched each persistent-participating SNFs up to 5 nonparticipating SNFs (1:5 nearest neighbor matching) using calipers with 0.02 standard deviation of the propensity scores with replacement. We used similar PS methods to find matched control SNFs for the drop-out group.

This matching process resulted in a standardized difference of 2% or less, implying the reliability of our PS approaches.

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Table 1A: Overview of variable definition and data source

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5

Dependent Variable Definitions Data Sources

Rate of 30-day readmission after initial SNF admission

If the SNF patient is admitted to hospital within 30-day following an

SNF admission MedPAR and MDS 3.0

Rate of 90-day readmission after initial SNF admission

If the SNF patient is admitted to hospital within 90-day following an SNF admission

Rate of successful discharge to community

If the SNF patient who is discharged to community within 100-day of SNF admission alive, is not admitted to a hospital for an unplanned inpatient admission, and is not admitted to a nursing home.

(https://www.cms.gov/Medicare/Provider-Enrollment-and

Certification/CertificationandComplianc/Downloads/Nursing-Home- Compare-Claims-based-Measures-Technical-Specifications.pdf)

MedPAR, MDS 3.0, and MBSF base segment

Independent Variable

Post If the episode started in the post-intervention period BPCI analytic files

(https://innovation.cms.gov/innovation- models/bundled-payments/archived-

materials ) Non-White-serving SNF If the SNF disproportionately serves residents who are racial/ethnic

non-White MDS 3.0 and MBSF base segment

Medicaid-dependent SNF If the SNF disproportionately serves residents who are Medicaid Persistent-participating SNF If the SNF participates and remains in the BPCI program

NHC and BPCI analytic files Drop-out SNF If the SNF participates initially then withdraws from the BPCI

program Covariates

Patient-level characteristics Age in years

MBSF base segment Race and ethnicity, %

White Black Hispanic Other Male gender, % Medicaid dual eligible,%

Married, %

MDS 3.0 Interpreter needed, %

Activities of daily living at SNF admission(0-28)

Cognitive function scale, % 0

1 2 3 PHQ-9, % <10 >=10

Hip replacement,%

MedPAR Elective admission, %

BPCI hospital,% BPCI analytic files

CJR hospital,% List of CJR hospitals

(https://innovation.cms.gov/innovation- models/cjr )

Chronic diseases, %

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MedPAR=Medicare Provider Analysis and Review; MDS=Minimum Data Set; MBSF=Master Beneficiary Summary File;

NHC=Nursing Home Compare; BPCI=Bundled Payments for Care Improvement; CMS=Centers for Medicare & Medicaid Services;

ACO=Accountable Care Organization; AHRF=Area Health Resources Files; MA=Medicare Advantage; CJR=Comprehensive Care for Joint Replacement.

Empirical model specifications

• i denotes patient i, j indicates SNF j, and t represents time t

• Post

_jt

: if the SNF in the post-intervention period (versus pre-intervention period)

• ^Persistent ^/Drop

out

SNF

_ijt

:if the patient was cared for in a persistent-participating/drop-out SNF

• SNF

_jt

: facility-level covariates

• ^County

jt

: county-level covariates

• State

_j

: state dummy variable

• ^Time

t

: quarterly dummy variable

• u

_ij

: all unobserved time-invariant factors

• ^e

jt

: all unobserved time-varying factors

Estimates of β

₄

and β

₅

quantitatively measure the associations of BPCI model 3 enrollment with changes in outcomes for persistent-participating SNFs and drop-out SNFs, respectively.

 ^Medicaid

j

: if the SNF is Medicaid-dependent

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The estimation strategies used and the covariates adjusted for in the model above are the same as those used in the previous DID model. Estimates of β

₁₀

and β

₁₁

quantitatively denote the relationships of the BPCI policy on across- facility racial/ethnic and socioeconomic status differences in outcomes of interest for persistent-participating SNFs and drop-out SNFs, respectively.

Table 2A: Tests of parallel trends assumption for rates of readmission and successful community discharge, 2013q1-2013q3 30-day readmission 90-day readmission Successful community

discharge Difference-in-Differences

Model

Coefficien t

P Coefficient P Coefficient P

Persistent -0.00 0.74 -0.00 0.74 0.03 0.03

Drop-out 0.02 0.09 0.02 0.14 -0.00 0.96

2013q2 -0.00 0.16 -0.00 0.39 0.00 0.65

2013q3 0.00 0.80 0.00 0.72 -0.01 0.01

Persistent*2013q2 -0.01 0.14 -0.02 0.51 0.12 0.36

Persistent*2013q3 -0.00 0.75 0.00 0.84 0.03 0.89

Drop-out*2013q2 -0.02 0.10 -0.02 0.21 0.02 0.30

Drop-out*2013q3 -0.01 0.68 -0.01 0.57 0.01 0.81

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The table above shows the results of parallel trends assumption tests, using linear regressions. In particular, the bolded interaction term coefficients are statistically insignificant, indicating the validity of our model specification.

Table 3A: Tests of parallel trends assumption for between-facility racial or SES differences in rates of readmission and successful community discharge, 2013q1-2013q3

Non-White-serving SNFs

30-day readmission 90-day readmission Successful community discharge Difference-in-Differences

Model

Coefficien t

Persistent -0.01 0.77 0.00 1.00 0.03 0.33

Drop-out 0.01 0.54 -0.01 0.85 0.02 0.48

2013q2 0.00 0.81 0.00 0.80 0.01 0.38

2013q3 0.00 0.81 0.00 0.71 -0.01 0.36

Persistent*2013q2 -0.05 0.10 -0.07 0.16 0.06 0.11

Persistent*2013q3 -0.02 0.50 0.00 0.96 0.02 0.74

Drop-out*2013q2 0.02 0.47 0.04 0.34 -0.06 0.10

Drop-out*2013q3 -0.01 0.73 -0.06 0.29 -0.02 0.77

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White-serving SNFs

Model

Coefficien t

Persistent -0.04 0.27 0.00 0.82 0.03 0.06

Drop-out -0.03 0.56 0.03 0.08 -0.01 0.69

2013q2 0.00 0.77 0.00 0.40 0.00 0.94

2013q3 0.00 0.83 0.00 0.97 -0.01 0.03

Persistent*2013q2 -0.03 0.46 -0.01 0.35 0.00 0.84

Persistent*2013q3 0.02 0.75 0.00 0.88 0.00 0.98

Drop-out*2013q2 0.02 0.75 -0.05 0.44 0.03 0.28

Drop-out*2013q3 -0.07 0.19 0.00 0.89 0.01 0.69

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Non-Medicaid-dependent SNFs

Model

Coefficien t

Persistent 0.00 0.60 -0.03 0.57 0.07 0.21

Drop-out 0.03 0.05 0.00 1.00 -0.01 0.93

2013q2 0.00 0.08 -0.01 0.22 0.02 0.12

2013q3 0.00 0.96 -0.02 0.07 0.03 0.02

Persistent*2013q2 0.00 0.63 -0.08 0.14 0.00 0.95

Persistent*2013q3 0.00 0.93 -0.02 0.75 -0.05 0.63

Drop-out*2013q2 -0.01 0.86 -0.01 0.92 -0.04 0.80

Drop-out*2013q3 -0.01 0.77 -0.12 0.08 0.04 0.83

Medicaid-dependent SNFs

Model

Coefficien t

Persistent 0.00 0.93 0.00 0.93 0.02 0.23

Drop-out 0.02 0.05 0.03 0.09 -0.01 0.44

2013q2 0.00 0.15 0.00 0.63 0.00 0.99

2013q3 0.00 0.88 0.00 0.59 -0.01 0.07

Persistent*2013q2 -0.01 0.17 -0.02 0.07 0.01 0.30

Persistent*2013q3 0.00 0.77 0.00 0.77 0.01 0.76

Drop-out*2013q2 -0.02 0.09 -0.03 0.20 0.02 0.21

Drop-out*2013q3 -0.01 0.79 -0.01 0.69 0.00 0.98

The tables above show the results of parallel trends assumption tests, using linear regressions. In particular, the bolded interaction term coefficients are statistically insignificant, indicating the validity of our model specification.

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Table 4A: Number of SNFs by year and SNF group for the 30-day readmission cohort

2013

BPCI SNF groups White-serving

SNFs

Nonparticipating SNFs 8,439 3,233

Persistent-participating SNFs 248 74

Drop-out SNFs 86 50

2014

Drop-out SNFs 87 58

2015

Drop-out SNFs 86 54

2016 Nonparticipating SNFs 8,428 3,257

Drop-out SNFs 80 52

2017

Drop-out SNFs 77 47

Table 5A: Distributions of episodes by year and SNF group for the 30-day readmission cohort

2013

BPCI SNF groups White-serving SNFs

Total

Nonparticipating SNFs 112,431 27,788 140,219

Persistent-participating SNFs 5,560 940 6,500

Drop-out SNFs 2,446 629 3,075

Total 120,437 29,357 149,794

2014

Persistent-participating SNFs 5,579 1,002 6,581

Drop-out SNFs 2,132 557 2,689

Total 116,722 28,112 144,834

2015

Drop-out SNFs 1,911 520 2,431

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Total 115,994 27,708 143,702

2016

Drop-out SNFs 1,624 437 2,061

Total 109,032 26,605 135,637

2017

Drop-out SNFs 727 189 916

Total 50,063 12,325 62,388

Table 6A: Distributions of readmits by year and SNF group for the 30-day readmission cohort

2013

BPCI SNF groups White-serving SNFs

Total

Persistent-participating SNFs 361 74 435

Total 8,337 2,417 10,754

2014

Total 7,917 2,235 10,152

2015

Total 8,378 2,290 10,668

2016

Total 7,908 2,280 10,188

2017

Total 3,737 1,067 4,804

Figure 2A: unadjusted 30-/90-day readmissions and rate of successful community discharge by SNF enrollment status

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BPCI

2013Q1 2013Q2

2013Q3 2013Q4

2014Q1 2014Q2

2014Q3 2014Q4

2015Q1 2015Q2

2015Q3 2015Q4

2016Q1 2016Q2

2016Q3 2016Q4

2017Q1 2017Q2 76.00

78.00 80.00 82.00 84.00 86.00 88.00 90.00

Successful community discharge

Control Per-sis- tent

2013Q1 2013Q2

2013Q3 2013Q4

2014Q1 2014Q2

2014Q3 2014Q4

2015Q1 2015Q2

2015Q3 2015Q4

2016Q1 2016Q2

2016Q3 2016Q4

2017Q1 2017Q2 8.00

10.00 12.00 14.00 16.00 18.00 20.00

90-day readmisison

Control Persistent Drop-out

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Table 7A: Characteristics of Skilled Nursing Facilities in Model 3 of Bundled Payments for Care Improvement Program, 2017Q2

Control

(n=28,891) Persistent

(n=1,423) Drop-out

(n=446) Persistent vs Control SNFs: P-value

Drop-out vs Control SNFs: P-value Mean ± SD or Prevalence (%)

Independent variables

Percent of Medicaid patients in nursing home 32.00 (20.19) 27.19 (16.48) 33.28 (16.07) <0.001 0.18 Percent of non-White patients in nursing home 15.03 (16.82) 14.17 (12.24) 17.05 (16.36) 0.05 0.01 Patient-level characteristics

Age in years 77.47 (9.17) 77.06 (9.15) 76.76 (9.46) 0.10 0.11

Race and ethnicity, %

White 85.70% 86.15% 83.41%

Black 7.16% 6.29% 10.99%

0.60 0.01

Hispanic 3.72% 3.85% 3.14%

Other 3.42% 3.71% 2.47%

Male gender, % 26.41% 28.32% 29.37% 0.11 0.16

Medicaid dual eligible,% 20.28% 16.85% 26.01% 0.002 0.003

Married, % 39.13% 41.91% 41.81% 0.04 0.27

Interpreter needed, % 1.97% 1.73% 1.38% 0.53 0.37

Activities of daily living at SNF admission(0-

28) 16.17 (4.13) 16.24 (3.90) 16.73 (3.89) 0.51 0.005

Cognitive function scale, %

0 78.60% 82.07% 75.48%

0.02 0.11

1 13.18% 11.04% 14.76%

2 7.17% 5.78% 7.62%

3 1.05% 1.11% 2.14%

PHQ-9, %

<10 90.75% 91.93% 91.08%

0.14 0.81

>=10 9.25% 8.07% 8.92%

Hip replacement,% 52.99% 50.07% 52.24% 0.03 0.75

Elective surgery, % 65.53% 69.72% 67.94% 0.001 0.29

BPCI hospital,% 12.99% 23.85% 13.23% <0.001 0.88

CJR hospital,% 26.34% -- 26.78% -- 0.71

Chronic diseases, %

Cancer 4.46% 4.94% 5.26% 0.51 0.50

Anemia 23.07% 22.98% 21.87% 0.94 0.55

Atrial Fibrillation or Other Dysrhythmias 17.97% 19.06% 18.42% 0.42 0.84

Coronary Artery Disease 16.01% 17.06% 18.42% 0.41

Deep Venous Thrombosis/Pulmonary 2.11% 1.65% 2.30% 0.36 0.81

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Embolus/Pulmonary Thrombo-Embolism

Heart Failure 6.85% 6.56% 8.20% 0.68 0.27

Hypertension 70.96% 68.59% 70.16% 0.06 0.71

Orthostatic Hypotension 0.59% 0.94% 0.91 0.11 0.39

Peripheral Vascular Disease/Peripheral

Arterial Disease 2.30% 1.79% 3.64% 0.21 0.06

Cirrhosis 0.39% 0.47% 1.32% 0.70 0.01

Gastroesophageal Reflux Disease/Ulcer 34.11% 36.65% 32.89% 0.35 0.66

Ulcerative Colitis, Crohn's Disease, or Inflammatory Bowel Disease

0.99% 1.53% 0.99% 0.12 1.00

Benign Prostatic Hyperplasia 7.21% 8.00% 6.58% 0.39 0.67

End Stage Renal Disease 9.33% 10.59% 12.83% 0.22 0.04

Neurogenic Bladder 0.08% 0.14% 0.00% 0.40 0.56

Obstructive Uropathy 0.31% 0.43% 0.45% 0.44 0.59

Multidrug-Resistant Organism 0.10% 0.07% 0.00% 0.73 0.50

Pneumonia 0.62% 0.50% 1.37% 0.60 0.05

Septicemia 0.08% 0.14% 0.00% 0.40 0.56

Tuberculosis 0.00% 0.07% 0.01% <0.001 0.89

Urinary Tract Infection 1.70% 1.71% 0.91% 0.98 0.20

Viral Hepatitis 0.33% 0.29% 0.00% 0.78 0.23

Wound Infection 0.28% 0.07% 0.00% 0.14 0.26

Diabetes Mellitus 21.48% 21.79% 25.68% 0.79 0.03

Hyponatremia 1.35% 1.01% 1.14% 0.28 0.70

Hyperkalemia 0.32% 0.14% 0.46% 0.25 0.63

Hyperlipidemia 43.33% 45.97% 41.69% 0.05 0.49

Thyroid Disorder 22.90% 22.47% 22.04% 0.77 0.72

Arthritis 47.49% 43.88% 52.63% 0.04 0.08

Osteoporosis 9.43% 9.76% 7.89% 0.74 0.36

Hip Fracture 15.86% 15.78% 14.12% 0.94 0.32

Other Fracture 2.17% 2.38% 3.19% 0.60 0.15

Alzheimer's Disease 2.02% 1.59% 2.05% 0.26 0.97

Aphasia 0.24% 0.14% 0.00% 0.47 0.30

Cerebral Palsy 0.13% 0.14% 0.00% 0.90 0.45

Cerebrovascular Accident, Transient Ischemic Attack, or Stroke

1.57% 0.94% 1.82% 0.06 0.67

Dementia 7.58% 5.55% 5.92% 0.005 0.19

Hemiplegia or Hemiparesis 0.65% 0.14% 0.91% 0.02 0.50

Paraplegia 0.01% 0.00% 0.00% 0.70 0.83

Quadriplegia 0.01% 0.00% 0.00% 0.70 0.83

Multiple Sclerosis 0.31% 0.07% 0.23% 0.11 0.75

Huntington's Disease 0.01% 0.00% 0.00% 0.70 0.70

Parkinson's Disease 2.29% 2.31% 1.37% 0.98 0.20

Tourette's Syndrome 0.00% 0.00% 0.00% 0.82 0.90

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Seizure Disorder or Epilepsy 2.25% 1.59% 2.28% 0.10 0.97

Traumatic Brain Injury 0.08% 0.14% 0.00% 0.40 0.56

Malnutrition 0.81% 0.36% 0.68% 0.06 0.77

Anxiety Disorder 15.20% 16.64% 16.59% 0.14 0.42

Depression 24.79% 26.66% 24.15% 0.12 0.76

Manic Depression 24.79% 16.66% 24.15% 0.12 0.76

Psychotic Disorder 0.54% 0.29% 0.91% 0.20 0.30

Schizophrenia 0.80% 0.71% 1.82% 0.72 0.02

Post Traumatic Stress Disorder 0.30% 0,07% 0.45% 0.12 0.57

Asthma, Chronic Obstructive Pulmonary

Disease (COPD), or Chronic Lung Disease 15.65% 17.80% 14.81% 0.03 0.63

Respiratory Failure 0.63% 0.43% 0.23% 0.37 0.29

Cataracts, Glaucoma, or Macular

Degeneration 7.99% 6.71% 5.92% 0.18 0.19

Facility-level characteristics

Number of beds 115.33 (75.11) 110.37 (56.26) 125.21 (47.43) 0.01 0.007

Nursing hours per resident day for

Registered nurses 1.24 (1.01) 1.20 (0.55) 0.99 (0.47) 0.16 <0.001

Licensed practical nurses 0.95 (0.57) 1.03 (0.58) 0.90 (0.29) <0.001 0.06

Certified nursing assistants 2.68 (0.73) 2.66 (0.60) 2.45 (0.50) 0.30 <0.001

Number of deficiency citations 5.79 (5.48) 4.59 (4.63) 6.72 (5.30) <0.001 <0.001

Ownership, %

For-profit 59.78% 64.06% 87.89%

<0.001 <0.001

Nonprofit 35.14% 35.66% 11.21%

Government-owned 5.07% 0.28% 0.90%

Chain affiliation, % 49.12% 78.39% 78.25% <0.001 <0.001

Hospital-based, % 9.86% 10.77% 1.12% 0.26 <0.001

Number of selected BPCI-episodes -- 13.97 (11.31) 3.72 (8.13) -- --

Market-level characteristics

Population aged 65 and older 131887.00 (219586.70)

153091.00 (184488.50)

147358.00 (187379.90)

<0.001 0.14

MA penetration 0.29 (0.12) 0.32 (0.11) 0.31 (0.10) <0.001 0.005

SNF beds per 10,000 360.61 (170.96) 320.35 (142.27) 342.57 (139.50) <0.001 0.03

ACO penetration 0.16 (0.12) 0.15 (0.10) 0.18 (0.10) <0.001 0.007

Urban,% 84.81 % 96.22% 89.69% <0.001 0.004

Market competition 0.86 (0.18) 0.91 (0.12) 0.88 (0.19) <0.001 0.004

Table 8A: Differential Changes in Readmissions and Successful Community Discharge, Sensitivity Analysis

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30-day readmissions,% 90-day readmissions,% Successful community discharge,%

(19)

Persistent-participating SNFs DID, adjusted Differential DID,

adjusted DID, adjusted Differential DID,

adjusted Estimate

(95% CI) P Differential

DID, adjusted P Estimate (95%

CI) P Differential

DID, adjusted P Estimate

(95% CI) P Differential

DID, adjusted P Main analysis

in manuscript Pre-BPCI

period:

2013q1-2013q3

All -0.55

(-1.69, 0.60) 0.35 -0.37

(-2.42, 1.67) 0.72 1.22

(-0.94, 3.38) 0.27 Non-White-

serving

-0.04 (-3.57,3.49)

0.98 0.38

(-4.63, 5.39)

0.88 -3.17

(-8.90, 2.56)

0.28 White-serving -2.19

(-3.80, -0.58)

0.008 2.15

(-1.68, 5.98)

0.52 -2.27

(-5.36, 0.82)

0.15 2.66

(-3.11, 8.42)

0.37 4.44

(1.45, 7.44)

0.00 4

-7.62 (-13.80, -1.43)

0.02 Medicaid-

dependent

-0.81 (-12.53, 10.92)

0.89 -1.83

(-15.99, 12.34)

0.80 7.20

(-4.31, 18.72) 0.22 Non-Medicaid-

dependent

-1.75 (-3.25, -0.24)

0.02 0.94

(-10.88, 12.76)

0.88 -1.61

(-4.36, 1.15)

0.25 -0.22

(-0.84, 1.29)

0.68 2.17

(-0.61, 4.95)

0.13 5.03

(-6.66, 16.73)

0.40

Sensitivity analysis Alternative cut

off point:

quintile Non-White- serving

0.40 (-3.80, 4.61)

0.85 -0.01

(-4.83, 4.80)

1.00 -1.82

(-8.06, 4.42)

(-3.74, -0.59)

0.007 2.57

(-1.88, 7.03)

0.26 -2.06

(-5.08, 0.96)

0.18 2.04

(-3.46, 7.55)

0.47 3.76

(0.80, 6.71)

0.01 -5.58

(-12.15, 0.99)

0.09 Medicaid-

dependent -0.40

(-13.91, 13.11) 0.95 -2.13

(-18.06, 13.79) 0.79 5.94

(-9.54, 21.43) 0.45 Non-Medicaid-

dependent -1.76

(-3.27, -0.26) 0.02 1.37

(-12.24, 14.97) 0.84 -1.62

(-4.36, 1.12) 0.25 -0.51

(-16.56, 15.54) 0.95 2.29

(-0.48, 5.06) 0.11 3.65 (-12.04,

19.34)

0.65

Alternative pre- BPCI period:

2012q4-2013q3

All -0.56

(-1.96, 0.84)

0.43 -0.40

(-2.45, 1.64)

0.70 1.39

(-0.71, 3.49)

0.20

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Non-White- serving

-0.73 (-4.45, 2.30)

0.70 0.62

(-4.27, 5.51)

0.80 -3.19

(-8.64, 2.27)

(-3.91, -0.45) 0.01 1.45

(-2.49, 5.39) 0.47 -2.41

(-5.50, 0.67) 0.13 3.03

(-2.61, 8.67) 0.29 4.62

(1.67, 7.56) 0.00

2 -7.80

(-13.68, -1.92) 0.009 Medicaid-

dependent

-0.66 (-14.01, 12.69)

0.92 -3.07

(-17.10, 10.97)

0.67 7.90

(-3.81, 19.61) 0.19 Non-Medicaid-

dependent

-1.92 (-3.57, -0.27)

0.02 1.26

(-12.14, 14.66)

0.85 -1.61

(-4.37, 1.14)

0.25 -1.45

(-15.66, 12.76)

0.84 2.25

(-0.48, 4.98)

0.11 5.64

(-6.24, 17.53)

0.35

2012q3-2013q3

All -0.50

(-1.86, 0.87)

0.48 -0.41

(-2.39, 1.56)

0.68 1.40

(-0.68, 3.48)

0.19 Non-White-

serving

-0.56 (-4.28, 3.15)

0.77 0.82

(-4.01, 5.66)

0.74 -3.39

(-8.82, 2.05)

(-3.81, -0.44) 0.01 1.56

(-2.36, 5.49) 0.43 -2.45

(-5.42, 0.53) 0.11 3.27

(-2.32, 8.86) 0.25 4.61

(1.66, 7.56) 0.00

2 -7.80

(-13.87, -2.12) 0.008 Medicaid-

dependent -1.04

(-13.10, 11.02) 0.87 -3.01

(-16.03, 10.01) 0.65 8.33

(-2.87, 19.53) 0.15 Non-Medicaid-

dependent

-1.81 (-3.45, -0.17)

0.03 0.77

(-11.40, 12.94)

0.90 -1.60

(-4.26, 1.06)

0.24 -1.41

(-14.66, 11.84)

0.84 2.17

(-0.57, 4.91)

0.12 6.16

(-5.23, 17.55)

0.29

Propensity score

All -0.16

(-1.31, 1.00) 0.79 0.06

(-1.62, 1.73) 0.95 0.51

(-1.37, 2.38) 0.60 Non-White-

serving 2.87

(-0.13, 5.88) 0.06 3.56

(-0.28, 7.40) 0.07 -2.23

(-8.23, 3.77) 0.47 White-serving -1.30

（-2.59，-0.01）

0.05 4.18

(0.98, 7.37)

0.01 -1.42

(-3.35, 0.52)

0.15 4.98

(0.90, 9.06)

0.02 3.75

(0.41, 7.10)

0.03 -5.99

(-12.26, 0.29)

0.06 Medicaid-

dependent 0.89

(-8.42, 10.21) 0.85 -0.12

(-7.83, 7.58) 0.98 7.70

(-3.21, 18.60) 0.17 Non-Medicaid-

dependent -2.80

(-4.88, -0.71) 0.008 3.69

(-5.89, 13.27) 0.45 -0.39

(-2.28, 1.50) 0.68 0.27

(-7.59, 8.13) 0.95 2.05

(-1.09, 5.20) 0.20 5.65

(-5.50, 16.79) 0.32

Drop-out SNFs Main analysis

in manuscript Pre-BPCI

period:

(21)

2013q1-2013q3

All -0.65

(-1.98, 0.67)

0.33 -0.05

(-2.21, 2.10)

0.96 1.21

(-0.81, 3.23)

0.24 Non-White-

serving

-1.79 (-4.16, 0.58)

0.14 0.31

(-3.31, 3.71)

0.86 0.26

(-4.20, 4.71)

0.91 White-serving -0.48

(-2.12, 1.16) 0.57 -1.31

(-3.98, 1.36) 0.34 0.43

(-2.06, 2.94) 0.73 -0.13

(-3.95, 3.69) 0.95 1.47

(-0.63, 3.58) 0.17 -1.22

(-5.85, 3.42) 0.61 Medicaid-

dependent

-1.98 (-9.40, 5.44)

0.60 -4.31

(-14.74, 6.13)

0.42 2.49

(-12.44, 17.42) 0.74 Non-Medicaid-

dependent

-0.70 (-2.22, 0.83)

0.37 -1.28

(-8.77, 6.20)

0.74 0.51

(-1.85, 2.88)

0.67 -4.82

(-15.42, 5.78)

0.37 1.05

(-1.03, 3.13)

0.32 1.44

(-13.54, 16.41)

0.85

Sensitivity analysis Alternative cut

off point:

quintile Non-White-

serving -1.83

(-4.55, 0.90) 0.19 0.64

(-3.06, 4.30) 0.73 0.17

(-4.02, 4.35) 0.94 White-serving -0.56

(-2.17, 1.07) 0.50 -1.27

(-4.29, 1.75) 0.41 0.36

(-2.09, 2.81) 0.78 0.29

(-3.80, 4.37) 0.89 1.44

(-0.66, 3.55) 0.18 -1.28

(-5.62, 3.06) 0.56 Medicaid-

dependent

2.84 (-11.04, 16.71)

0.69 -7.61

(-23.02, 7.81)

0.33 -5.42

(-26.68, 15.83) 0.62 Non-Medicaid-

dependent

-0.73 (-2.24, 0.78)

0.35 3.56

(-10.34, 17.46)

0.62 0.54

(-1.80, 2.88)

0.65 -8.14

(-23.69, 7.40)

0.30 1.17

(-0.91, 3.26)

0.27 -6.59

(-27.87, 14.69)

0.54

2012q4-2013q3

All -0.69

(-2.30, 0.92) 0.40 -0.12

(-2.23, 1.99) 0.91 1.08

(-0.91, 3.69) 0.29 Non-White-

serving

-0.93 (-3.58, 1.71)

0.49 0.34

(-3.07, 3.76)

0.84 0.32

(-3.98, 4.62)

0.88 White-serving -0.80

(-2.70, 1.10)

0.41 -0.35

(-1.89, 1.19)

0.66 0.34

(-2.11, 2.78)

0.79 0.00

(-3.82, 3.83)

1.00 1.24

(-0.85, 3.33)

0.25 -0.92

(-5.35, 3.52)

0.69 Medicaid-

dependent -1.77

(-9.35, 5.81)

0..65 -4.74

(-14.85, 5.37)

0.36 2.19

(-12.57, 16.95) 0.77 Non-Medicaid-

dependent -0.85

(-2.63, 0.94)

0.35 -0.92

(-8.58, 6.73)

0.81 0.45

(-1.87, 2.77)

0.71 -5.19

(-15.46, 6.08)

0.32 0.94

(-1.14, 3.01)

0.38 1.25

(-13.55, 16.05)

0.87

(22)

2012q3-2013q3

All -0.61

(-2.20, 0.97)

0.45 -0.04

(-2.12, 2.05)

0.97 0.94

(-1.00, 2.88)

0.34 Non-White-

serving -1.01

(-3.71, 1.69) 0.46 0.45

(-3.00, 3.90) 0.80 0.40

(-3.95, 4.74) 0.86 White-serving -0.69

(-2.56, 1.19)

0.47 -0.33

(-3.21, 2.56)

0.83 0.43

(-2.01, 2.86)

0.73 0.02

(-3.85, 3.89)

0.99 1.02

(-1.01, 3.04)

0.33 -0.62

(-5.07, 3.83)

0.78 Medicaid-

dependent -1.92

(-9.47, 5.62)

0.62 -4.77

(-14.80, 5.26)

0.35 2.38

(-12.28, 17.03) Non-Medicaid-

dependent -0.74

(-2.51, 1.03)

0.41 -1.18

(-8.81, 6.44) 0.76 0.55

(-1.77, 2.86) 0.64 -5.32

(-15.52, 4.88) 0.31 0.74

(-1.30, 2.77) 0.48 1.64 (-13.07,

16.34)

0.83

Propensity score approach

All 0.05

(-0.83, 0.92)

0.92 -0.06

(-1.21, 1.09)

0.92 0.12

(-1.35, 1.59)

0.87 Non-White-

serving -1.11

(-3.10, 0.88)

0.27 0.52

(-2.23, 3.32)

0.72 0.62

(-2.81, 4.06)

0.72

White-serving 0.92

(-0.08, 1.91)

0.07 -2.03

(-4.25, 0.20) 0.08 0.66

(-0.59, 1.91) 0.30 -0.14

(-3.19, 2.91) 0.93 0.03

(-1.40, 1.46) 0.97 0.60

(-3.09, 4.28) 0.75 Medicaid-

dependent 4.94

(-0.80, 10.68)

0.09 -0.29

(-4.96, 4.38) 0.90 7.70

(-3.21, 18.60) 0.17 Non-Medicaid-

dependent 0.40

(-1.08, 1.88)

0.59 4.54

(-1.38, 10.45)

0.13 0.68

(-0.51, 1.86)

0.27 -0.97

(-5.79, 3.86)

0.69 2.05

(-1.09, 5.20)

0.20 5.65

(-5.49, 16.78)

0.32

95% CI=95% confidence interval; DID=difference-in-differences; BPCI=Bundled Payments for Care Improvement

(23)

Table 9A: The Full Output of The Effects of the BPCI Model 3 on 30-day Readmissions

Variable name Estimated

coefficient

Robust Stander

error

P-value 95% lower confidence interval

95% upper confidence interval BPCI group

Persistent -0.0043 0.0042 0.3140 -0.0126 0.0040

Dropout 0.0026 0.0043 0.5460 -0.0058 0.0110

Post 0.0023 0.0032 0.4850 -0.0041 0.0086

Persistent * Post -0.0055 0.0058 0.3500 -0.0169 0.0060

Dropout * Post -0.0066 0.0068 0.3320 -0.0198 0.0067

Percent of Medicaid patients in nursing home 0.0001 0.0000 0.0210 0.0000 0.0001 Percent of non-White patients in nursing home 0.0001 0.0000 0.0010 0.0001 0.0002

Age in years -0.0001 0.0000 0.1300 -0.0002 0.0000

Race

Black 0.0005 0.0015 0.7420 -0.0024 0.0034

Hispanic -0.0078 0.0020 0.0000 -0.0118 -0.0038

Other -0.0093 0.0021 0.0000 -0.0134 -0.0053

Gender

Male 0.0120 0.0009 0.0000 0.0101 0.0138

Medicare-Medicaid dual enrollment

Medicare-only -0.0077 0.0010 0.0000 -0.0098 -0.0057

Marital status

Not married -0.0014 0.0007 0.0560 -0.0028 0.0000

Interpreter needed -0.0116 0.0028 0.0000 -0.0171 -0.0061

Activities of daily living at SNF admission (0- 28)

0.0037 0.0001 0.0000 0.0035 0.0039

Cognitive function scale

Mild 0.0478 0.0015 0.0000 0.0450 0.0507

Moderate 0.0313 0.0019 0.0000 0.0277 0.0350

Severe -0.0213 0.0042 0.0000 -0.0296 -0.0130

PHQ-9

>=10 0.0899 0.0021 0.0000 0.0857 0.0941

(24)

Elective surgery -0.0124 0.0012 0.0000 -0.0146 -0.0101

Hip replacement 0.0166 0.0008 0.0000 0.0150 0.0182

Chronic disease

Cancer 0.0025 0.0017 0.1440 -0.0009 0.0060

Anemia -0.0066 0.0008 0.0000 -0.0082 -0.0051

Atrial Fibrillation or Other Dysrhythmias 0.0249 0.0011 0.0000 0.0228 0.0270

Coronary Artery Disease 0.0123 0.0010 0.0000 0.0104 0.0143

Deep Venous Thrombosis/Pulmonary Embolus/Pulmonary Thrombo-Embolism

0.0359 0.0030 0.0000 0.0300 0.0418

Heart Failure 0.0148 0.0017 0.0000 0.0115 0.0180

Hypertension -0.0064 0.0008 0.0000 -0.0080 -0.0049

Orthostatic Hypotension -0.0145 0.0050 0.0040 -0.0242 -0.0047

Peripheral Vascular Disease/Peripheral Arterial Disease

0.0034 0.0023 0.1450 -0.0012 0.0079

Cirrhosis 0.0401 0.0086 0.0000 0.0233 0.0569

Gastroesophageal Reflux Disease/Ulcer 0.0039 0.0007 0.0000 0.0025 0.0053 Ulcerative Colitis, Crohn's Disease, or

Inflammatory Bowel Disease

0.0100 0.0036 0.0060 0.0028 0.0171

Benign Prostatic Hyperplasia 0.0024 0.0017 0.1560 -0.0009 0.0058

End Stage Renal Disease 0.0372 0.0017 0.0000 0.0339 0.0405

Neurogenic Bladder -0.0022 0.0072 0.7580 -0.0163 0.0119

Obstructive Uropathy -0.0135 0.0085 0.1090 -0.0301 0.0030

Multidrug-Resistant Organism -0.0088 0.0078 0.2600 -0.0240 0.0065

Pneumonia -0.0096 0.0042 0.0240 -0.0178 -0.0013

Septicemia 0.0348 0.0214 0.1050 -0.0073 0.0768

Tuberculosis -0.0503 0.0334 0.1320 -0.1158 0.0151

Urinary Tract Infection -0.0166 0.0017 0.0000 -0.0200 -0.0131

Viral Hepatitis -0.0028 0.0070 0.6940 -0.0165 0.0110

Wound Infection 0.0100 0.0040 0.0120 0.0022 0.0179

Diabetes Mellitus 0.0046 0.0008 0.0000 0.0030 0.0062

Hyponatremia -0.0064 0.0031 0.0410 -0.0126 -0.0003

Hyperkalemia -0.0057 0.0070 0.4170 -0.0195 0.0081

Hyperlipidemia -0.0148 0.0007 0.0000 -0.0161 -0.0134

(25)

Thyroid Disorder 0.0012 0.0008 0.1500 -0.0004 0.0027

Arthritis -0.0244 0.0008 0.0000 -0.0260 -0.0228

Osteoporosis -0.0077 0.0010 0.0000 -0.0097 -0.0057

Hip Fracture -0.0314 0.0012 0.0000 -0.0337 -0.0290

Other Fracture -0.0117 0.0025 0.0000 -0.0166 -0.0069

Alzheimer's Disease -0.0547 0.0024 0.0000 -0.0595 -0.0499

Aphasia -0.0212 0.0070 0.0030 -0.0350 -0.0074

Cerebral Palsy -0.0293 0.0100 0.0030 -0.0489 -0.0097

-0.0103 0.0024 0.0000 -0.0149 -0.0057

Dementia -0.0314 0.0016 0.0000 -0.0345 -0.0282

Hemiplegia or Hemiparesis -0.0096 0.0048 0.0460 -0.0189 -0.0002

Paraplegia 0.0272 0.0345 0.4300 -0.0404 0.0948

Quadriplegia 0.0264 0.0581 0.6500 -0.0875 0.1402

Multiple Sclerosis -0.0037 0.0061 0.5450 -0.0157 0.0083

Huntington's Disease -0.0325 0.0366 0.3730 -0.1042 0.0391

Parkinson's Disease -0.0055 0.0025 0.0240 -0.0103 -0.0007

Tourette's Syndrome -0.0364 0.0229 0.1120 -0.0813 0.0085

Seizure Disorder or Epilepsy -0.0033 0.0025 0.1780 -0.0082 0.0015

Traumatic Brain Injury -0.0327 0.0111 0.0030 -0.0545 -0.0109

Malnutrition -0.0164 0.0039 0.0000 -0.0239 -0.0088

Anxiety Disorder -0.0078 0.0010 0.0000 -0.0096 -0.0059

Depression -0.0026 0.0009 0.0050 -0.0044 -0.0008

Manic Depression -0.0004 0.0016 0.8290 -0.0035 0.0028

Psychotic Disorder -0.0231 0.0039 0.0000 -0.0306 -0.0155

Schizophrenia 0.0053 0.0044 0.2330 -0.0034 0.0140

Post Traumatic Stress Disorder -0.0144 0.0065 0.0270 -0.0271 -0.0016

Asthma, Chronic Obstructive Pulmonary Disease (COPD), or Chronic Lung Disease

0.0126 0.0010 0.0000 0.0106 0.0146

Respiratory Failure 0.0078 0.0071 0.2700 -0.0061 0.0218

Cataracts Glaucoma, or Macular -0.0073 0.0012 0.0000 -0.0096 -0.0049

(26)

Degeneration

BPCI hospital 0.0031 0.0018 0.0920 -0.0005 0.0066

CJR hospital 0.0053 0.0023 0.0200 0.0008 0.0098

Number of beds 0.0000 0.0000 0.0310 0.0000 0.0000

Nursing hours per resident day for

Registered nurses 0.0016 0.0007 0.0220 0.0002 0.0029

Licensed practical nurses 0.0031 0.0009 0.0000 0.0014 0.0047

Certified nursing assistants -0.0016 0.0006 0.0100 -0.0027 -0.0004

Number of deficiency citations 0.0003 0.0001 0.0000 0.0001 0.0004

Ownership

Nonprofit 0.0002 0.0010 0.8320 -0.0018 0.0023

Government-owned -0.0057 0.0022 0.0110 -0.0100 -0.0013

Chain affiliation -0.0014 0.0009 0.1110 -0.0032 0.0003

Hospital-based 0.0050 0.0021 0.0160 0.0010 0.0091

Number of selected BPCI-episodes 0.0001 0.0002 0.5760 -0.0003 0.0005

Population aged 65 and older 0.0000 0.0000 0.3440 0.0000 0.0000

MA penetration 0.0041 0.0052 0.4290 -0.0060 0.0142

SNF beds per 10, 000 0.0000 0.0000 0.0020 0.0000 0.0000

ACO penetration -0.0064 0.0044 0.1430 -0.0150 0.0022

Urban 0.0042 0.0014 0.0020 0.0015 0.0069

Market Competition 0.0096 0.0030 0.0010 0.0038 0.0154

State dummy /

Quarterly dummy /

Table 10A: The Full Output of The Effects of the BPCI Model 3 on Racial Disparities in 30-day Readmissions

(27)

Variable name Estimated coefficient

Robust Stander

error

P-value 95% lower confidence interval

95% upper confidence interval

(28)

BPCI group

Persistent -0.0047 0.0044 0.2830 -0.0134 0.0039

Dropout 0.0039 0.0048 0.4100 -0.0054 0.0133

Post 0.0038 0.0033 0.2500 -0.0027 0.0103

Persistent * Post -0.0219 0.0082 0.0080 -0.0380 -0.0058

Dropout * Post -0.0048 0.0084 0.5670 -0.0213 0.0116

Minority SNF 0.0056 0.0020 0.0060 0.0016 0.0097

Persistent * Minority SNF -0.0060 0.0080 0.4550 -0.0218 0.0098

Dropout * Minority SNF 0.0067 0.0066 0.3130 -0.0063 0.0197

Post * Minority SNF -0.0054 0.0021 0.0090 -0.0095 -0.0014

Persistent * Post * Minority SNF 0.0215 0.0195 0.2710 -0.0168 0.0598

Dropout * Post * Minority SNF -0.0131 0.0136 0.3360 -0.0398 0.0136

Percent of Medicaid patients in nursing home 0.0001 0.0000 0.0000 0.0001 0.0002

Age in years 0.0000 0.0001 0.9270 -0.0001 0.0001

Race

Black 0.0027 0.0016 0.1000 -0.0005 0.0059

Hispanic -0.0050 0.0023 0.0260 -0.0095 -0.0006

Other -0.0080 0.0023 0.0010 -0.0126 -0.0034

Gender

Male 0.0115 0.0011 0.0000 0.0094 0.0136

Medicare-Medicaid dual enrollment

Medicare-only -0.0072 0.0012 0.0000 -0.0095 -0.0049

Marital status

Not married -0.0008 0.0008 0.3560 -0.0024 0.0008

Interpreter needed -0.0103 0.0032 0.0010 -0.0165 -0.0041

Activities of daily living at SNF admission (0- 28)

0.0037 0.0001 0.0000 0.0035 0.0039

Cognitive function scale

Mild 0.0497 0.0016 0.0000 0.0465 0.0528

Moderate 0.0321 0.0021 0.0000 0.0279 0.0363

Severe -0.0212 0.0047 0.0000 -0.0305 -0.0120

PHQ-9

(29)

>=10 0.0891 0.0023 0.0000 0.0846 0.0937

Elective surgery -0.0121 0.0013 0.0000 -0.0146 -0.0095

Hip replacement 0.0161 0.0009 0.0000 0.0143 0.0178

Chronic disease

Cancer 0.0017 0.0019 0.3740 -0.0021 0.0056

Anemia -0.0071 0.0009 0.0000 -0.0088 -0.0054

Atrial Fibrillation or Other Dysrhythmias 0.0249 0.0012 0.0000 0.0225 0.0273

Coronary Artery Disease 0.0121 0.0011 0.0000 0.0099 0.0143

Deep Venous Thrombosis/Pulmonary Embolus/Pulmonary Thrombo-Embolism

0.0373 0.0034 0.0000 0.0307 0.0439

Heart Failure 0.0151 0.0019 0.0000 0.0114 0.0189

Hypertension -0.0067 0.0009 0.0000 -0.0084 -0.0049

Orthostatic Hypotension -0.0149 0.0058 0.0100 -0.0263 -0.0036

Peripheral Vascular Disease/Peripheral Arterial Disease

0.0011 0.0026 0.6630 -0.0040 0.0063

Cirrhosis 0.0444 0.0105 0.0000 0.0238 0.0650

Gastroesophageal Reflux Disease/Ulcer 0.0041 0.0008 0.0000 0.0026 0.0057

Ulcerative Colitis, Crohn's Disease, or Inflammatory Bowel Disease

0.0103 0.0041 0.0120 0.0023 0.0184

Benign Prostatic Hyperplasia 0.0025 0.0019 0.1970 -0.0013 0.0063

End Stage Renal Disease 0.0379 0.0020 0.0000 0.0340 0.0418

Neurogenic Bladder -0.0035 0.0074 0.6350 -0.0181 0.0111

Obstructive Uropathy -0.0131 0.0104 0.2080 -0.0336 0.0073

Multidrug-Resistant Organism -0.0096 0.0084 0.2520 -0.0260 0.0068

Pneumonia -0.0120 0.0047 0.0110 -0.0212 -0.0027

Septicemia 0.0325 0.0269 0.2280 -0.0203 0.0853

Tuberculosis -0.0372 0.0373 0.3180 -0.1103 0.0358

Urinary Tract Infection -0.0169 0.0019 0.0000 -0.0206 -0.0132

Viral Hepatitis 0.0007 0.0083 0.9360 -0.0156 0.0169

Wound Infection 0.0104 0.0042 0.0140 0.0021 0.0187

Diabetes Mellitus 0.0049 0.0009 0.0000 0.0031 0.0067

Hyponatremia -0.0078 0.0036 0.0290 -0.0148 -0.0008

Hyperkalemia -0.0060 0.0081 0.4590 -0.0219 0.0099

(30)

Hyperlipidemia -0.0144 0.0008 0.0000 -0.0159 -0.0128

Thyroid Disorder 0.0007 0.0009 0.4550 -0.0011 0.0024

Arthritis -0.0240 0.0009 0.0000 -0.0258 -0.0222

Osteoporosis -0.0078 0.0011 0.0000 -0.0100 -0.0056

Hip Fracture -0.0283 0.0014 0.0000 -0.0310 -0.0256

Other Fracture -0.0110 0.0028 0.0000 -0.0166 -0.0055

Alzheimer's Disease -0.0545 0.0028 0.0000 -0.0600 -0.0489

Aphasia -0.0178 0.0084 0.0340 -0.0342 -0.0013

Cerebral Palsy -0.0219 0.0119 0.0670 -0.0452 0.0015

-0.0094 0.0026 0.0000 -0.0145 -0.0043

Dementia -0.0307 0.0018 0.0000 -0.0343 -0.0271

Hemiplegia or Hemiparesis -0.0117 0.0056 0.0370 -0.0227 -0.0007

Paraplegia 0.0323 0.0398 0.4180 -0.0458 0.1104

Quadriplegia 0.0668 0.0810 0.4090 -0.0919 0.2255

Multiple Sclerosis -0.0117 0.0069 0.0900 -0.0252 0.0018

Huntington's Disease -0.0180 0.0439 0.6820 -0.1041 0.0681

Parkinson's Disease -0.0058 0.0028 0.0380 -0.0113 -0.0003

Tourette's Syndrome -0.0404 0.0230 0.0800 -0.0855 0.0048

Seizure Disorder or Epilepsy -0.0023 0.0028 0.4110 -0.0079 0.0032

Traumatic Brain Injury -0.0372 0.0123 0.0030 -0.0613 -0.0130

Malnutrition -0.0138 0.0045 0.0020 -0.0227 -0.0049

Anxiety Disorder -0.0078 0.0011 0.0000 -0.0100 -0.0057

Depression -0.0024 0.0009 0.0110 -0.0043 -0.0006

Manic Depression 0.0033 0.0033 0.3220 -0.0032 0.0097

Psychotic Disorder -0.0240 0.0044 0.0000 -0.0325 -0.0154

Schizophrenia 0.0019 0.0051 0.7090 -0.0081 0.0119

Post Traumatic Stress Disorder -0.0150 0.0076 0.0490 -0.0300 -0.0001

Asthma, Chronic Obstructive Pulmonary Disease (COPD), or Chronic Lung Disease

0.0125 0.0012 0.0000 0.0103 0.0148

Respiratory Failure 0.0103 0.0092 0.2640 -0.0078 0.0283

Cataracts Glaucoma, or Macular Degeneration

-0.0073 0.0013 0.0000 -0.0099 -0.0047

https://links.lww.com/MLR/C569

Categorizations of non-White-serving SNFs and Medicaid-dependent SNFs

Sensitivity Analyses: Propensity Score Approach

Empirical model specifications

1. Difference-in-differences model specification

To examine the association of SNF participation in bundled payments with patient outcomes among Medicare beneficiaries undergoing lower extremity joint replacement, we performed a DID regression. The model was specified as follows:

Outcome

=β

+ β

Post

+ β

Persistent SNF

+ β

Drop

SNF

+ β

Post

∗Persistent SNF

+ β

Post

∗Drop

SNF

+ β

SNF

+ β

County

+ β

State

+ β

Time

+u

+e

• Outcome includes 30-/90-day readmissions, rate of successful discharge to community

• i denotes patient i, j indicates SNF j, and t represents time t

• Post

: if the SNF in the post-intervention period (versus pre-intervention period)

• Persistent /Drop

SNF

:if the patient was cared for in a persistent-participating/drop-out SNF

• SNF

: facility-level covariates

• County

: county-level covariates

• State

: state dummy variable

• Time

: quarterly dummy variable

• u

: all unobserved time-invariant factors

• e

: all unobserved time-varying factors

Estimates of β

and β

quantitatively measure the associations of BPCI model 3 enrollment with changes in outcomes for persistent-participating SNFs and drop-out SNFs, respectively.

2. Difference-in-differences model specification

To evaluate the association of SNF participation in bundled payments with possible racial/ethnic and socioeconomic status differences in patient outcomes across facilities. The model was specified as follows:

Outcome

=β

+ β

Post

+ β

Persistent SNF

+ β

Drop

SNF

+ β

Post

∗Persistent SNF

+ β

Post

∗Drop

+ β

Minority ( Medicaid )

+ β

Minority ( Medicaid )

∗Persistent SNF

+ β

Minority ( Medicaid )

∗Drop

+

• ^Persistent ^/Drop

• ^County

• ^Time

• ^e

 ^Medicaid