Hospitals' plea will soon be nursing homes'

James M. Berklan
James M. Berklan

I was truly surprised when I didn't hear long-term care leaders excitedly jumping around, yelling, “See! See! Us too! Us too!” last week. It was a simple report, sure, but one that should have sent the frantic-meter bouncing.

The source of excitement was a new report published online by JAMA Internal Medicine. In brief, researchers identified almost two dozen characteristics associated with higher hospital readmissions that aren't taken into account by the Centers for Medicare & Medicaid Services.

“Hospitals with high readmission rates may be penalized to a large extent based on the patients they serve;” the researchers concluded.

That is big trouble for some hospitals because CMS is reducing Medicare reimbursements in fiscal 2016 by up to 3% for those whose readmission rates are too high.

Medicare's hospital readmissions calculations take into account discharge diagnosis and recent diagnoses, as well as factors such as age and gender. But that's hardly enough.

Guess who's next in line to start losing reimbursement for rehospitalization rates that are too high? That would be nursing home operators. Starting in 2018, they will get their own graduated formula for having Medicare funding stripped when they have poor rehospitalization numbers.

Just as hospitals now lament that income and education levels, and other aspects, of their patients are influencing rehospitalization rates, skilled nursing providers will join the chorus. Actually, they have already, just not too loudly. Wheels are turning, however.

It is believed, in fact, that some providers have started to adjust their admissions criteria so they do not get “stuck” with residents more likely to be readmitted to the hospital within 30 days of an acute-care discharge.

This JAMA Internal Medicine study, and others soon to be like it, surely can expect to be referred to in the months and years to come.

To be fair, CMS and other healthcare experts are struggling with how to fairly judge hospitals (and soon nursing homes) that care for higher-acuity individuals — as well as patients who exhibit (m)any of the 22 characteristics associated with higher readmission rates that aren't now accounted for.

The good news is national quality and Medicare officials are actively trying to develop a trial program that would study risk-adjusting factors. The Medicare Payment Advisory Commission and various provider groups have endorsed the move.

It's especially good news because recent legislative efforts to adjust calculations based on additional factors have been lukewarm at best and have fizzled out.

Expect some added fizz, however, as nursing homes themselves get closer to losing Medicare funding based on rehospitalization rates. The frantic-meter will no doubt be bouncing by then.

James M. Berklan is McKnight's Editor. Follow him @JimBerklan.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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