R. Tamara Konetzka

Research Summary
R. Tamara Konetzka, PhD, is the Louis Block Professor of Public Health Sciences in the Department of Public Health Sciences, with a secondary appointment in the Department of Medicine, Section of Geriatrics and Palliative Medicine. She is an internationally recognized expert in the health economics of long-term and post-acute care. Her research focuses on the incentives created by health care policy, including payment policy, and their effects on quality of care. She has been the PI on numerous major federal research grants, leading to significant advances in knowledge of the drivers of nursing home quality, how public reporting of quality changes the behavior of providers and consumers, and the unintended consequences of home-based long-term and post-acute care. In May 2020 and again in March 2021, she testified before the U.S. Senate on COVID-19 and nursing homes. Konetzka serves on several editorial boards and is Editor in Chief of Medical Care Research and Review.
Health Economics, Long-Term Care, Post-Acute Care, Medicaid, Medicare
  • University of Pennsylvania and Philadelphia VA, Post-doctoral fellowship Health Economics 06/2004
  • University of North Carolina at Chapel Hill, PhD Health Policy and Administration (Health Economics) 08/2003
  • University of Pennsylvania, AM Economics 12/1992
Biosciences Graduate Program Association
Awards & Honors
  • 2014 - - Invited member, Five-Star Quality Rating System Technical Expert Panel (TEP) Centers for Medicare and Medicaid Services
  • 2019 - - Standing Member NIH HSOD/ODHS Study Section
  • 2020 - - Member, Committee on the Quality of Care in Nursing Homes National Academy of Sciences, Engineering, and Medicine
  • 2020 - Invited Testimony on COVID-19 and Nursing Homes, US Senate Special Committee on Aging
  • 2021 - - Invited Testimony on COVID-19 and Nursing Homes US Senate Finance Committee
  1. Association of Staffing Instability With Quality of Nursing Home Care. JAMA Netw Open. 2023 01 03; 6(1):e2250389. View in: PubMed

  2. Association of COVID-19 Vaccination Rates of Staff and COVID-19 Illness and Death Among Residents and Staff in US Nursing Homes. JAMA Netw Open. 2022 12 01; 5(12):e2249002. View in: PubMed

  3. Predicting Hospitalization among Medicaid Home- and Community-Based Services Users Using Machine Learning Methods. J Appl Gerontol. 2023 02; 42(2):241-251. View in: PubMed

  4. Associations Between Daily Nurse Staffing Levels and Daily Hospitalizations and ED Visits in Nursing Homes. J Am Med Dir Assoc. 2022 11; 23(11):1793-1799.e3. View in: PubMed

  5. Trends In Medicaid Home And Community-Based Services Waivers For Older Adults. Health Aff (Millwood). 2022 08; 41(8):1176-1181. View in: PubMed

  6. Beyond Compliance: A More Integrated Public Health Approach To Outbreaks In Nursing Homes And Other Disasters. Health Aff (Millwood). 2022 06; 41(6):831-837. View in: PubMed

  7. Reforming Nursing Home Financing, Payment, and Oversight. N Engl J Med. 2022 05 19; 386(20):1869-1871. View in: PubMed

  8. Estimating the Impact of Medicaid Expansion and Federal Funding Cuts on FQHC Staffing and Patient Capacity. Milbank Q. 2022 06; 100(2):504-524. View in: PubMed

  9. Daily Variation in Nursing Home Staffing and Its Association With Quality Measures. JAMA Netw Open. 2022 03 01; 5(3):e222051. View in: PubMed

  10. The Inevitability of Reimagining Long-Term Care. J Am Med Dir Assoc. 2022 02; 23(2):187-189. View in: PubMed

  11. Reimagining Financing and Payment of Long-Term Care. J Am Med Dir Assoc. 2022 02; 23(2):220-224. View in: PubMed

  12. Trends in Receipt of Help at Home After Hospital Discharge Among Older Adults in the US. JAMA Netw Open. 2021 11 01; 4(11):e2135346. View in: PubMed

  13. Trends in Post-Acute Care in US Nursing Homes: 2001-2017. J Am Med Dir Assoc. 2021 12; 22(12):2491-2495.e2. View in: PubMed

  14. A systematic review of long-term care facility characteristics associated with COVID-19 outcomes. J Am Geriatr Soc. 2021 10; 69(10):2766-2777. View in: PubMed

  15. Consumer selection and home health agency quality and patient experience stars. Health Serv Res. 2022 02; 57(1):113-124. View in: PubMed

  16. Medicaid home- and community-based services and discharge from skilled nursing facilities. Health Serv Res. 2021 12; 56(6):1156-1167. View in: PubMed

  17. The Quality Measures Domain in Nursing Home Compare: Is High Performance Meaningful or Misleading? Gerontologist. 2022 Feb 09; 62(2):293-303. View in: PubMed

  18. The Metrics Matter: Improving Comparisons of COVID-19 Outbreaks in Nursing Homes. J Am Med Dir Assoc. 2021 05; 22(5):955-959.e3. View in: PubMed

  19. Wealth and the utilization of long-term care services: evidence from the United States. Int J Health Econ Manag. 2021 Sep; 21(3):345-366. View in: PubMed

  20. Addressing Systemic Racism in Nursing Homes: A Time for Action. J Am Med Dir Assoc. 2021 04; 22(4):886-892. View in: PubMed

  21. Factors Associated With Racial Differences in Deaths Among Nursing Home Residents With COVID-19 Infection in the US. JAMA Netw Open. 2021 02 01; 4(2):e2037431. View in: PubMed

  22. Improving the Fate of Nursing Homes During the COVID-19 Pandemic: The Need for Policy. Am J Public Health. 2021 Apr; 111(4):632-634. View in: PubMed

  23. The Effects of Home Care Provider Mix on the Care Recipient: An International, Systematic Review of Articles from 2000 to 2020. Annu Rev Public Health. 2021 04 01; 42:483-503. View in: PubMed

  24. Outcomes of Medicaid home- and community-based long-term services relative to nursing home care among dual eligibles. Health Serv Res. 2020 12; 55(6):973-982. View in: PubMed

  25. Nothing Much Has Changed: COVID-19 Nursing Home Cases and Deaths Follow Fall Surges. J Am Geriatr Soc. 2021 01; 69(1):46-47. View in: PubMed

  26. Inside the Black Box of Improving on Nursing Home Quality Measures. Med Care Res Rev. 2021 12; 78(6):758-770. View in: PubMed

  27. Staffing Levels and COVID-19 Cases and Outbreaks in U.S. Nursing Homes. J Am Geriatr Soc. 2020 11; 68(11):2462-2466. View in: PubMed

  28. Informal And Formal Home Care For Older Adults With Disabilities Increased, 2004-16. Health Aff (Millwood). 2020 08; 39(8):1297-1301. View in: PubMed

  29. Claims-based Frailty Indices: A Systematic Review. Med Care. 2020 09; 58(9):815-825. View in: PubMed

  30. The Challenges of Improving Nursing Home Quality. JAMA Netw Open. 2020 Jan 03; 3(1):e1920231. View in: PubMed

  31. The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs. Health Serv Res. 2019 12; 54(6):1184-1192. View in: PubMed

  32. Consumer Response to Composite Ratings of Nursing Home Quality. Am J Health Econ. 2019; 5(2):165-190. View in: PubMed

  33. Assessing the Relative Contribution of Resident Versus Facility Characteristics Associated With Antipsychotic Medication Receipt Among Nursing Facility Residents. Med Care. 2019 10; 57(10):822-829. View in: PubMed

  34. A National Examination Of Long-Term Care Setting, Outcomes, And Disparities Among Elderly Dual Eligibles. Health Aff (Millwood). 2019 07; 38(7):1110-1118. View in: PubMed

  35. Association Between High Discharge Rates of Vulnerable Patients and Skilled Nursing Facility Copayments. JAMA Intern Med. 2019 Sep 01; 179(9):1296-1298. View in: PubMed

  36. Medicaid and Nursing Home Choice: Why Do Duals End Up in Low-Quality Facilities? J Appl Gerontol. 2020 09; 39(9):981-990. View in: PubMed

  37. Scalability of an IT Intervention to Prevent Pressure Ulcers in Nursing Homes. J Am Med Dir Assoc. 2019 07; 20(7):816-821.e2. View in: PubMed

  38. What is the marginal benefit of payment-induced family care? Impact on Medicaid spending and health of care recipients. Health Econ. 2019 05; 28(5):678-692. View in: PubMed

  39. Patient Outcomes After Hospital Discharge to Home With Home Health Care vs to a Skilled Nursing Facility. JAMA Intern Med. 2019 05 01; 179(5):617-623. View in: PubMed

  40. Use of instrumental variables for endogenous treatment at the provider level. Health Econ. 2019 05; 28(5):710-716. View in: PubMed

  41. Are Recessions Good for Staffing in Nursing Homes? Am J Health Econ. 2018; 4(4):411-432. View in: PubMed

  42. Does Nursing Home Compare Reflect Patient Safety In Nursing Homes? Health Aff (Millwood). 2018 11; 37(11):1770-1778. View in: PubMed

  43. Effects of long-term care setting on spousal health outcomes. Health Serv Res. 2019 02; 54(1):158-166. View in: PubMed

  44. Malpractice Environment vs Direct Litigation: What Drives Nursing Home Exit? Inquiry. 2018 Jan-Dec; 55:46958018787995. View in: PubMed

  45. Association Between 5-Star Nursing Home Report Card Ratings and Potentially Preventable Hospitalizations. Inquiry. 2018 Jan-Dec; 55:46958018787323. View in: PubMed

  46. Measuring State Medicaid Home Care Participation and Intensity Using Latent Variables. J Appl Gerontol. 2020 07; 39(7):731-744. View in: PubMed

  47. Trends in hospital-SNF relationships in the care of Medicare beneficiaries. Healthc (Amst). 2018 Sep; 6(3):175-179. View in: PubMed

  48. Trends in Post-Acute Care Use Among Medicare Beneficiaries: 2000 to 2015. JAMA. 2018 04 17; 319(15):1616-1617. View in: PubMed

  49. Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs. Am J Health Econ. 2018; 4(1):105-130. View in: PubMed

  50. The effect of integration of hospitals and post-acute care providers on Medicare payment and patient outcomes. J Health Econ. 2018 09; 61:244-258. View in: PubMed

  51. Insights about the economic impact of chronic obstructive pulmonary disease readmissions post implementation of the hospital readmission reduction program. Curr Opin Pulm Med. 2018 03; 24(2):138-146. View in: PubMed

  52. Nursing Home Response to Nursing Home Compare: The Provider Perspective. Med Care Res Rev. 2019 08; 76(4):425-443. View in: PubMed

  53. The Relationship Between Reported Staffing and Expenditures in Nursing Homes. Med Care Res Rev. 2019 12; 76(6):758-783. View in: PubMed

  54. Relationships between Acute and Postacute Care Providers: Measurement and Estimation. Health Serv Res. 2017 10; 52(5):1621-1628. View in: PubMed

  55. Use Of Nursing Home Compare Website Appears Limited By Lack Of Awareness And Initial Mistrust Of The Data. Health Aff (Millwood). 2016 Apr; 35(4):706-13. View in: PubMed

  56. An Evaluation of Performance Thresholds in Nursing Home Pay-for-Performance. Health Serv Res. 2016 Dec; 51(6):2282-2304. View in: PubMed

  57. Are Home- and Community-Based Services Cost-Effective? Med Care. 2016 Mar; 54(3):219-20. View in: PubMed

  58. Changes in Consumer Demand Following Public Reporting of Summary Quality Ratings: An Evaluation in Nursing Homes. Health Serv Res. 2016 Jun; 51 Suppl 2:1291-309. View in: PubMed

  59. Understanding the Context for Long-Term Care Planning. Med Care Res Rev. 2016 06; 73(3):349-68. View in: PubMed

  60. Prevalence of pseudobulbar affect symptoms and clinical correlates in nursing home residents. Int J Geriatr Psychiatry. 2016 07; 31(7):694-701. View in: PubMed

  61. Response. Chest. 2015 Oct; 148(4):e134-e135. View in: PubMed

  62. The Role of Severe Dementia in Nursing Home Report Cards. Med Care Res Rev. 2015 Oct; 72(5):562-79. View in: PubMed

  63. Nursing home 5-star rating system exacerbates disparities in quality, by payer source. Health Aff (Millwood). 2015 May; 34(5):819-27. View in: PubMed

  64. Family structure and long-term care insurance purchase. Health Econ. 2015 Mar; 24 Suppl 1:58-73. View in: PubMed

  65. The causal effects of home care use on institutional long-term care utilization and expenditures. Health Econ. 2015 Mar; 24 Suppl 1:4-17. View in: PubMed

  66. Understanding why patients with COPD get readmitted: a large national study to delineate the Medicare population for the readmissions penalty expansion. Chest. 2015 May; 147(5):1219-1226. View in: PubMed

  67. Quantifying long-term care preferences. Med Decis Making. 2015 01; 35(1):106-13. View in: PubMed

  68. Public Reporting and Demand Rationing: Evidence from the Nursing Home Industry. Health Econ. 2015 Nov; 24(11):1437-51. View in: PubMed

  69. How Can Adult Children Influence Parents' Long-Term Care Insurance Purchase Decisions? Gerontologist. 2017 04 01; 57(2):292-299. View in: PubMed

  70. The hidden costs of rebalancing long-term care. Health Serv Res. 2014 Jun; 49(3):771-7. View in: PubMed

  71. Using time trade-off methods to assess preferences over health care delivery options: a feasibility study. Value Health. 2014 Mar; 17(2):302-5. View in: PubMed

  72. The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment. J Am Geriatr Soc. 2014 Mar; 62(3):454-61. View in: PubMed

  73. Quality improvement under nursing home compare: the association between changes in process and outcome measures. Med Care. 2013 Jul; 51(7):582-8. View in: PubMed

  74. Malpractice litigation and nursing home quality of care. Health Serv Res. 2013 Dec; 48(6 Pt 1):1920-38. View in: PubMed

  75. The effect of pay-for-performance in nursing homes: evidence from state Medicaid programs. Health Serv Res. 2013 Aug; 48(4):1393-414. View in: PubMed

  76. The impact of profitability of hospital admissions on mortality. Health Serv Res. 2013 Apr; 48(2 Pt 2):792-809. View in: PubMed

  77. Shipping out instead of shaping up: rehospitalization from nursing homes as an unintended effect of public reporting. J Health Econ. 2013 Mar; 32(2):341-52. View in: PubMed

  78. Users of Medicaid home and community-based services are especially vulnerable to costly avoidable hospital admissions. Health Aff (Millwood). 2012 Jun; 31(6):1167-75. View in: PubMed

  79. A longitudinal analysis of the impact of hospital service line profitability on the likelihood of readmission. Med Care Res Rev. 2012 Aug; 69(4):414-31. View in: PubMed

  80. Do consumers respond to publicly reported quality information? Evidence from nursing homes. J Health Econ. 2012 Jan; 31(1):50-61. View in: PubMed

  81. Provider expectations and experiences of comanagement. J Hosp Med. 2011 Sep; 6(7):401-4. View in: PubMed

  82. The pay-off on nursing home report cards. LDI Issue Brief. 2011 Apr; 16(6):1-4. View in: PubMed

  83. Changes in patient sorting to nursing homes under public reporting: improved patient matching or provider gaming? Health Serv Res. 2011 Apr; 46(2):555-71. View in: PubMed

  84. Performing well on nursing home report cards: does it pay off? Health Serv Res. 2011 Apr; 46(2):531-54. View in: PubMed

  85. Explaining lapse in long-term care insurance markets. Health Econ. 2011 Oct; 20(10):1169-83. View in: PubMed

  86. Effects of provider characteristics on care coordination under comanagement. J Hosp Med. 2010 Nov-Dec; 5(9):508-13. View in: PubMed

  87. Advancing nursing home quality through quality improvement itself. Health Aff (Millwood). 2010 Jan-Feb; 29(1):81-6. View in: PubMed

  88. Applying market-based reforms to long-term care. Health Aff (Millwood). 2010 Jan-Feb; 29(1):74-80. View in: PubMed

  89. Do not-for-profit nursing homes provide better quality? BMJ. 2009 Aug 04; 339:b2683. View in: PubMed

  90. Impact of public reporting on quality of postacute care. Health Serv Res. 2009 Aug; 44(4):1169-87. View in: PubMed

  91. Disparities in long-term care: building equity into market-based reforms. Med Care Res Rev. 2009 Oct; 66(5):491-521. View in: PubMed

  92. Impact of public reporting on unreported quality of care. Health Serv Res. 2009 Apr; 44(2 Pt 1):379-98. View in: PubMed

  93. Managed care and hospital cost containment. Inquiry. 2008; 45(1):98-111. View in: PubMed

  94. Will mandated minimum nurse staffing ratios lead to better patient outcomes? Med Care. 2008 Jun; 46(6):606-13. View in: PubMed

  95. The staffing-outcomes relationship in nursing homes. Health Serv Res. 2008 Jun; 43(3):1025-42. View in: PubMed

  96. Reducing hospitalizations from long-term care settings. Med Care Res Rev. 2008 Feb; 65(1):40-66. View in: PubMed

  97. General internists' views on pay-for-performance and public reporting of quality scores: a national survey. Health Aff (Millwood). 2007 Mar-Apr; 26(2):492-9. View in: PubMed

  98. Medicare payment changes and nursing home quality: effects on long-stay residents. Int J Health Care Finance Econ. 2006 Sep; 6(3):173-89. View in: PubMed

  99. Medicare prospective payment and quality of care for long-stay nursing facility residents. Med Care. 2006 Mar; 44(3):270-6. View in: PubMed

  100. Did recent changes in Medicare reimbursement hit teaching hospitals harder? Acad Med. 2005 Nov; 80(11):1069-74. View in: PubMed

  101. Effect of cuts in Medicare reimbursement on process and outcome of care for acute myocardial infarction patients. Circulation. 2005 Oct 11; 112(15):2268-75. View in: PubMed

  102. Effects of nursing home ownership type and resident payer source on hospitalization for suspected pneumonia. Med Care. 2004 Oct; 42(10):1001-8. View in: PubMed

  103. Effects of Medicare payment changes on nursing home staffing and deficiencies. Health Serv Res. 2004 Jun; 39(3):463-88. View in: PubMed