Steven Littlehale, EVP and Chief Clinical Officer, PointRight Inc.
Change is in the wind. The National Quality Forum has recommended for endorsement a new metric that measures a skilled nursing facility's ability to manage the long-stay population, specifically in terms of hospitalization prevention.
To date, similar measures have focused exclusively on the first 30 days after an acute hospital stay, a very different cohort. This new metric is important, considering that over 60% of SNF residents are long-stay patients, many of whom are at end of life, with a terminal illness or heightened frailty. Hospitalization of this population is often associated with negative consequences; in 2015 the national average of long-stay hospitalization was 14.15%, with performance ranging from 0% to 20.26%.
This recommended MDS-based measure is correlated with other measures of quality, including Five-Star and our own. Higher Five-Star ratings are associated with lower adjusted long-stay hospitalization rates, and the relationship is strongest for the Quality and RN Staffing domains.
State and federal regulators, providers and payers such as Medicaid Managed Care benefit from using this metric to assess facility performance, set appropriate improvement goals, and establish long-stay value-based incentives. Only 30% of SNFs have performance in short-stay rehospitalization align with their performance in long-stay hospitalization.
Often, there is a disconnect between facility performance with regards to short-stay patients and long-stay residents. Clinicians will tell you that risk factors for rehospitalization and hospitalization are different; still, one might expect greater “spill-over” of practice from one cohort to another. Are the two groups so different?
One distinct difference in the long-stay population is mortality. How well do we recognize end-of-life (EOL) in our long-stay population? Proper identification and attention to this cohort could significantly drive your rate of hospitalization down.
In our 2015 study, 9.76% of long-stay residents are at EOL. Furthermore, 16.25% of long-stay residents who were hospitalized were at EOL at the time of hospitalization.
The introduction of this hospitalization metric enables providers to focus on hospitalization rates among the long-stay population. Evidence-based practice, root cause analysis and quality improvement will emerge.
What best practices can you share?