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What can skilled nursing facilities do now that they are being held accountable for hospital readmissions after SNF discharge?

Dr. Andy Kramer
Provider Magazine – June 2015

After practicing for so many decades in silos, hospitals, skilled nursing facilities (SNFs), home health agencies, and hospices need to work together to prevent unnecessary readmissions over 30-day periods, not just on their own watches.

The HospitalReadmission Reduction Program put pressure on hospitals to reduce readmissions in the 30 days aer hospital discharge, and now the IMPACT Act of 2014 is intended to give SNFs a financial incentive to avoid unneeded readmissions during the same period.

According to the Centers for Medicare & Medicaid Services (CMS) fiscal year 2016 Proposed Rule for SNFs, the agency is proposing to apply a SNF readmission measure to the SNF Value-Based Purchasing Program. In this measure, a readmission “…is counted in the numerator regardless of whether the patient is readmitted directly from the SNF or has been discharged from the SNF.”

‘Now the problem is more complicated than just focusing on the SNF stay.’

Most of the focus in SNFs to date has been on preventing readmission during the SNF stay, which occurs in the first 30 days for about 17 percent of Medicare SNF admissions. Many of us have spoken about and provided tools to track, understand the root cause, and reduce these readmissions from SNFs.

But now the problem is more complicated than just focusing on the SNF-stay portion of the 30 days. About 40 percent of Medicare SNF stays continue without a readmission for 30 days, and about 3 percent of SNF beneficiaries die within 30 days, leaving 40 percent of Medicare beneficiaries who are discharged from the SNF within 30 days of the hospital discharge to a location other than the acute hospital.

So where do these SNF discharges within 30 days go? It turns out that about 7 percent of SNF admissions go on to get long term care in the same or a different nursing center. Another 33 percent go to the community, with slightly more than half of those (about 17 percent) getting home health care.

It is hard to track those not getting either of these types of care, some of whom may be getting hospice services or be followed as outpatients.

Transfers from SNF to long term care had an average readmission rate of 8 percent in the 30-day period following the hospital discharge. The SNF stays for these residents averaged 17 days, so these readmissions generally occurred in less than two weeks following transfer to long term care.

SNF stays resulting in home health discharges average 19 days, with an average readmission rate of 5.3 percent. But with more than twice as many SNF residents discharged to community with home health care than long term care, home health accounts for almost twice as many readmissions within 30 days of hospital discharge.

With SNFs and hospitals both accountable for readmissions in this 30-day window, there is an opportunity to engage the hospital once you have the necessary data on readmissions. I recommend that you review the long term care and home health providers you are partnering with to understand when, why, and from which location readmissions are occurring.

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