Guest Columns

This blog makes me think of 'Seinfeld'

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Steven Littlehale
Steven Littlehale

Jerry Seinfeld's successful nine-season comedy sitcom was a “show about nothing,” yet it won more than 40 international awards. Although this blog might not receive such international acclaim, it reminds me of “Seinfeld” because it is about, well, almost nothing.

So, why did I write it? And, why are you still reading it? Maybe it's the "Seinfeld" reference, but let's see …

Last month's blog, “Maybe you don't want to be in that preferred network ...” attempted to help you better understand your competitive environment. We explored the hospital Overall Quality Rating (Star Rating) and the hospital readmission rate, and investigated correlations between SNF rehospitalization rates. There were clear relationships identified and knowing how you compare to your competition helps to create a strategy for strengthening relationships with your referring hospitals. That was something!

Then I baited you. I teased you with this: “Next month we'll examine the relationship between the Hospital and SNF Five-Star ratings.” I was confident that there would be “super cool” insights that would rival Kramer and Frank Costanza's (George's Dad's) invention of “The Bro” (aka the man bra), or the insights presented in January. There were not. So why did I pursue?

Flashback to graduate school when Professor Larkin helped me cope when my research hypotheses were not supported by the findings of my study — he was extraordinarily kind when he helped me realize that sometimes the absence of a finding is in-and-of-itself, a finding.

Back to this blog: There is no clear relationship between a hospital's overall Star Rating and the SNF Five-Star Rating. Nothing … but perhaps my blog about nothing is actually about something.

I recall that this investigation was inspired by an operator who felt that bad performing hospitals were the cause of her Five-Star woes. Well “bad performing hospitals,” as measured by their star rating, are not. Instead, it's more effective to dig into your Five-Star Rating and identify the opportunity for improvement.

The hypothesized relationship simply doesn't exist. But just like Seinfeld made us laugh for years at “nothing,” there are a few final comments which may satisfy.

First, Hospital Star Ratings are negatively correlated with SNF occupancy. This means that SNFs operating in the same Hospital Referral Region (HRR) as a well-performing hospital (as defined by Five-Star) will have lower occupancy.

Second, the Hospital Five-Star Rating is based on a broad set of measures, much more so than the SNF Five-Star Quality Rating System. It could well be that well-performing hospitals safely discharge directly to a lower care setting (Home Health); therefore, if you are a SNF relying on a well-rated hospital for referrals, your best strategy might be to collaborate with Home Health.

Step in to support the Home Health Agency avoid rehospitalizations and emergency department visits, develop creative collaboratives with the community and target the most acute patients who couldn't possibly be effectively managed at home.

Let's face it: In these markets, specializing in uncomplicated post-surgical orthopedic rehab isn't likely a winning strategy.

Steven Littlehale is a gerontological clinical nurse specialist, and executive vice president and chief clinical officer at PointRight Inc.

Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.