Validating SNF Utilization Measures

We used Medicare, Medicaid, and MDS data in the analyses. Most of the validation analyses were performed with linked Medicare-Medicaid data from Texas. We selected all beneficiaries who were enrolled in full Medicare Parts A and B and had full Medicaid coverage in Texas from 1/1/11 to 12/31/11 or date of death (n = 575,472). We also constructed another cohort consisting of the 9,022 enrollees in the cohort above who had a SNF stay within 3 days of hospital discharge between 01/01/2011 and 6/30/2011. This cohort also had full Medicare Part A and B, no health maintenance organization (HMO) in 2011, and no nursing facility service within 3 months prior to hospital discharge. We followed each patient in this cohort 180 days after SNF admission. We used Medicaid charges for LTC Services as a gold standard to assess the sensitivity and positive predictive value (PPV) of the other measures, similar to other investigators [12 (link)].