Hospital readmission penalties for SNFs pose 'critical problems,' researchers say

Communication between SNFs, hospitals and residents is needed, researchers say
Communication between SNFs, hospitals and residents is needed, researchers say

A provision of the Protecting Access to Medicare Act that will penalize both the skilled nursing facility and hospital for rehospitalizations will require SNFs to address some “critical problems,” according to a new report.

The rehospitalization provision, set to go into effect in 2018, would hold both hospitals and SNFs responsible for any patient that returns to the hospital within 30 days of discharge.

While that set-up is beneficial to patients, it poses a new set of risks for SNF operators, said Jennifer Carnahan, M.D., MPH, of the Indiana University Center for Aging Research. Carnahan, along with other researchers from Indiana University and the Regenstrief Institute contributed to “Hospital Readmission Penalties: Coming Soon to a Nursing Home Near You,” published in the March issue of the Journal of the American Geriatrics Society.

"By making SNFs more accountable for the care they provide by initiating a 30-day readmission penalty rule, the federal government is advocating for patients," Carnahan wrote in the report. “But as physician-researchers, we believe there will be critical problems for patient care that need to be addressed before this provision … rolls out.”

Among those problems is a lack of communication between hospitals and SNFs, and between SNFs, residents and their families. SNF staff can improve that communication by giving guidance to patients being discharged home so they understand things like medication instruction and further therapy needs, the researchers said

Providers also should consider the potential to keep patients longer than may be medically necessary if they believe they can do a better job at keeping the resident out of the hospital than the resident could do at home.

"We need to evaluate each patient's home environment to improve transitions of care," Carnahan said. “These things are nuanced. When is a patient back to pre-hospitalization baseline? Should a patient be kept in a SNF for 20 days simply because Medicare will pay for it?”

The new rehospitalization penalties also add to the incentives for SNFs to increase their clinical capabilities, and provide a higher level of medical care in-house, researchers said.  

That advice is in tune with a new payment model recently unveiled by the Centers for Medicare & Medicaid Services to reduce rehospitalizations. Under the model, SNFs would receive increased payments to purchase new equipment and conduct staff training to provide treatments such as intravenous therapy and cardiac monitoring.