Readmission rates decline when hospitals develop skilled nursing facility networks

September 5, 2017, Columbia University's Mailman School of Public Health
Credit: CC0 Public Domain

A new study on hospital re-admission rates found that hospitals with formal networks of skilled nursing facilities as part of their care management efforts had reduced readmission rates among patients discharged to skilled nursing facilities as compared to hospitals without such networks, according to researchers at Columbia University's Mailman School of Public Health. The findings will be published in the September issue of the journal Health Affairs.

Re-hospitalization rate for patients discharged to skilled nursing facilities declined from 24 percent in 2009 to 18 percent in 2013, compared with 21.5 percent to 20 percent for hospitals without skilled nursing facility networks.

"The hospitals with formal networks of skilled nursing facilities recognize that care management among patients transitioning to a skilled nursing facility is just as important as managing patients discharged to home, particularly because the former are often sicker and have more complex health care needs," said John Mc Hugh, PhD, MBA, assistant professor of Health Policy and Management at the Mailman School of Public Health.

While there has been a steady decrease in re-hospitalization rates nationally, many of the reasons for these reductions had been unclear until this study.

The U.S. Centers for Medicare and Medicaid Services (CMS) has been focusing on reducing unplanned readmissions and established a penalty for hospitals beginning in 2012. Currently, the penalty is a 3 percent reduction in Medicare payments.

To determine changes in re-hospitalization rates and differences in practices, the researchers analyzed data gathered from interviews during site visits to hospitals in eight U.S. cities in March to October 2015 and combined this information with Medicare claims data for the period 2009 to 2013. Mc Hugh and colleagues identified four hospitals, representing two sites, that had developed a formal network of preferred nursing facilities.

Nearly 27,000 Medicare patients were discharged from four hospitals with formal skilled nursing facility networks—or case hospitals—and more than 54,000 Medicare patients were discharged from 12 hospitals without such networks. The four hospitals sent a greater proportion of Medicare patients—one out of 3—to a skilled nursing facility—versus one out of 4 patients in the comparison hospitals.

Several overarching themes emerged from the study. For example, hospitals leveraged their existing relationships and built their preferred networks using facilities where they had historically discharged a high percentage of patients. "This is an important finding because it shows that hospitals were able to adhere to the choice requirements set by CMS and not have to diverge from historic referral patterns with their discharge planners," observed Mc Hugh.

"Current debates about the value of "narrow networks" vs. patient choice of post-acute care setting should be informed by this study since hospitals investing in creating preferred post-acute care providers clearly seem to gain in the form of reduced rates of rehospitalization which is good for the and for their patients," said co-author Vincent Mor, PhD, professor of Health Services, Policy, and Practice at the Brown University School of Public Health.

The researchers also noted that certain cost drivers stimulated establishing a skilled network, hospitals were able to leverage high volumes at network facilities, and effective data management was critical. Each of the hospitals had a contractual relationship but no direct financial relationship with the preferred skilled nursing facilities in their network.

"The leadership teams of the hospitals with skilled nursing facility networks focused organizational efforts on developing these preferred networks," said McHugh. More specifically, the hospitals had formal processes in place to identify participating facilities and during the discharge process the hospitals often provided patients with printed materials about the network facilities available.

"We also learned that while nearly all hospitals had processes to manage patients discharged to home, only four had recognized the advantages of developing formal networks of facilities. Some had begun the process of developing networks, only to abandon it," noted McHugh. "It is important for hospitals to recognize the elevated re-hospitalization risk of discharged to these facilities. The costs associated with developing a are relatively small, yet the benefits can be significant."

Explore further: Hospitalized older adults may need more help selecting skilled nursing facilities

Related Stories

Hospitalized older adults may need more help selecting skilled nursing facilities

July 7, 2017
More than 20 percent of all hospitalized older adults who use Medicare will be admitted to a skilled nursing facility following a stay in the hospital (also known as "post-acute care"). However, these men and women may be ...

Investing more in inpatient care relative to longer-term nursing facilities reduces mortality rates

July 10, 2017
Hospitals that spend more on initial care following patient emergencies have better outcomes than hospitals that spend less at first and rely more on additional forms of long-term care, according to a new study co-authored ...

Longer hospital stays might reduce readmissions from post-acute care facilities

March 7, 2017
More than 25 percent of Medicare beneficiaries who are admitted to the hospital are sent to a post-acute care facility (a health facility like a rehabilitation or skilled nursing center used instead of a hospital) after being ...

Readmission from skilled nursing facility often avoidable

December 22, 2016
(HealthDay)—A considerable proportion of hospital readmissions from skilled nursing facilities (SNFs) are considered potentially avoidable, according to a study published online Dec. 16 in the Journal of the American Geriatrics ...

Hospitals in Medicare ACOs reduced readmissions faster

January 9, 2017
Hospitals in Medicare Accountable Care Organizations outpaced non-ACO hospitals in reducing the rate at which patients discharged to skilled nursing facilities (SNFs) needed to return to the hospital, according to a new study ...

Recommended for you

Whether sustained or sporadic, exercise offers same reductions in death risk

March 22, 2018
For decades, Americans have been inundated with a confusing barrage of messages about how best to counteract the health risks of sedentary lifestyles: walk 10,000 steps a day; do a seven-minute workout from a phone app; flip ...

Tai chi as good as or better than aerobic exercise for managing chronic pain

March 21, 2018
The ancient martial art of tai chi has similar or greater benefits than aerobic exercise for people with the chronic pain condition fibromyalgia, finds a trial published by The BMJ today.

Study: Poor health is a less common cause of bankruptcy than commonly thought, but it brings other economic woes

March 21, 2018
A team of researchers led by an MIT economist has found that medical expenses account for roughly 4 percent of bankruptcy filings among nonelderly adults in the U.S.

Medical expansion has improved health—with one exception

March 21, 2018
While Americans debate the rising cost of health care, a new study of 30 countries over 27 years found that medical expansion has improved overall health - with one major exception.

Study finds bad sleep habits start early in school-age children

March 21, 2018
Bad sleep habits in children begin earlier than many experts assume. That's the takeaway from a new study led by McGill University researchers. The findings suggest that official sleep guidelines for young school children ...

Forgetting details, getting the gist may prompt false memories in older adults

March 21, 2018
Older adults often complain about forgetting, but Penn State psychologists suggest that another problem may be misremembering.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.