Differences in Skilled Nursing Facility Characteristics and Quality Ratings by Long-Term Care Pharmacy Provider

ObjectivesLimited data exist on the U.S. long-term care (LTC) pharmacy market and how skilled nursing facilities (SNFs) may differ by LTC pharmacy provider. We estimated the market shares of two major LTC pharmacies (Omnicare and PharMerica) and assessed if SNF characteristics differ by pharmacy. DesignCross-sectional. Setting and ParticipantsSeventy-five Rhode Island (RI) SNFs that provided post-acute care (PAC) services in 2019. MethodsSNF location, structure, staffing measures, and quality ratings were ascertained from publicly available data sources. The LTC pharmacy used by each SNF was compiled by case managers at a RI health system. ResultsAmong 75 SNFs, 32 (43%) were served by Omnicare and 36 (48%) by PharMerica. LASSO logistic regression and random forest models identified 5 key predictors of SNFs selecting PharMerica over Omnicare: number of skilled beds, total number of beds, nursing hours per resident per day, five-star health inspection rating, and average number of residents per day. In a multivariable regression model including 4 predictors (total number of beds excluded due to collinearity), SNFs had a 6% higher prevalence of using Omnicare over PharMerica for every additional 10 skilled beds (Prevalence Ratio 1.06, 95% CI 1.02-1.10). Conclusions and ImplicationsOmnicare and PharMerica comprised over 90% of the SNF PAC market in RI, with Omnicare covering larger facilities. Understanding if these companies serve a similar proportion of SNFs in other U.S. states is necessary to advance future research initiatives and examine how collaborations between SNFs and LTC pharmacy chains may improve medication management in SNFs. Brief SummaryTwo pharmacies may comprise over 90% of the skilled nursing facility post-acute care market. This market concentration may represent a prime opportunity to efficiently improve medication management.