If the Medicare Payment Advisory Commission (MedPAC) gets its way, skilled nursing facilities whose patients often end up back in the hospital within 30 days of discharge will face the same kind of financial penalties as hospitals.
In its March report to Congress, MedPAC states, “We recommend reducing payments to SNFs with relatively high rates of rehospitalizations. Avoidable rehospitalizations of SNF patients increase Medicare’s spending, expose beneficiaries to additional disruptive care transitions, and can result in hospital-acquired infections or other adverse health consequences.” In essence MedPAC is saying preventable readmissions are not just a hospital’s problem; patient care and transitions require a collaborative effort with SNFs, like hospitals, being held accountable for positive outcomes.
MedPAC recommends that if a patient is readmitted from a SNF within 30 days of discharge, the stay would count in both SNF and hospital measures. Doing this would give the hospital an incentive to avoid prematurely discharging a patient, and the SNF would be motivated to manage the care it furnishes to avoid an unnecessary rehospitalization.
If a preventable rehospitalization occurred more than 30 days after discharge and while the beneficiary was still in the SNF, the rehospitalization would count against the SNF but not the hospital. MedPAC is saying the SNF should be held accountable in this case, because the underlying cause of the rehospitalization is more likely the quality of care received at the SNF rather than a premature discharge or the care received at the hospital.
Typically, Congress will hold one or more hearings to listen to MedPAC commissioners and staff. At that point, it’s up to Congress whether any legislation will be introduced based on these recommendations.
Steps SNFs Should Take Now.
While hospitals should be looking at readmission reports (see pages 17-22) by placement, provider, physician and diagnosis to identify root cause of readmissions, SNFs should:
• Review clinical data. Look at the reasons why a patient was rehospitalized. If the patient arrived and was not well, was it a premature discharge? If the patient’s health status wasn’t clinically correct, were there errors in the discharge instructions? Were medication instructions unclear? SNFs should immediately address such issues and any related data discrepancies with case managers to reduce problems.
• Identify and address trends. If SNFs see troubling trends from a specific hospital, they should address these with case managers as well. This may mean reviewing the thoroughness and timing of discharge plans. SNFs should also work with hospitalists and attending MDs who have discharged patients who require rehospitalization to determine how better to identify the patient’s needs before accepting the referral.
• Address high-risk rehospitalization conditions. From a clinical point of view, SNFs know the potentially avoidable conditions resulting in readmissions. SNFs should look at care plans and staffing patterns to ensure they can effectively treat patients and recognize when rehospitalization is the most appropriate and medically necessary option.
• Be willing to refuse a referral. Some hospitals do discharge a high volume of patients who are ultimately readmitted. If such hospitals are unwilling to collaborate with a SNF on patient-transition improvements, declining a referral may be the better decision for the patient and the SNF.
Jackie Birmingham, RN, MS, is vice president, emeritus, of clinical leadership at Curaspan Health Group.
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> Post-Acute Providers Work to Cut Rehospitalizations
> Connectivity is Key for Post-Acute Collaboration with Hospitals
> Using Technology, Data for a Better Post-Acute Care Experience
> Best Practices for Discharge Planning from a Post-Acute Perspective
> Information Kit for Post-Acute Providers