ArticleHealth affairs scholar2026
Do policy context and structural disadvantage shape SNF VBP performance? Evidence from national facility-year data.
Article in Health affairs scholar, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Introduction: Skilled nursing facility (SNF) performance under the Centers for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program is intended to reflect quality of care but may also be shaped by broader policy and structural contexts. This study evaluates whether Medicaid expansion status and structural disadvantage, measured using the Structural Racism Effects Index (SREI), are associated with high SNF performance. Methods: We conducted a pooled repeated cross-sectional analysis of facility-level data from fiscal years 2019-2021 and 2024, including 57 816 facility-year observations. High performance was defined as a total SNF VBP score ≥50 (upper quartile). Multivariable logistic regression estimated associations between Medicaid expansion, SREI, and high performance, adjusting for ownership, facility size, resident census, nurse staffing, prior penalties, and year. Results: Facilities in Medicaid expansion states had higher odds of high performance (aOR = 1.19; 95% CI: 1.13-1.24), while greater structural disadvantage was associated with lower odds (OR = 0.87; 95% CI: 0.85-0.89). Higher registered nurse staffing was associated with better performance, while ownership, LPN staffing, and penalties were not significant. Conclusion: SNF performance reflects both policy and structural conditions. Without accounting for these factors, value-based payment models may reinforce existing inequities.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.