Referrals funnel duals into lower quality nursing homes

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Specially trained RNs could help reduce avoidable hospitalizations, results suggest.
Specially trained RNs could help reduce avoidable hospitalizations, results suggest.

Government health programs could save money and health outcomes could improve if more dual-eligible beneficiaries were to go from hospitals to well-staffed long-term and post-acute facilities, according to research from Brown and Harvard universities.

Hospital patients eligible both for Medicare and Medicaid are discharged to nursing homes with low nurse-to-patient ratios more commonly than Medicare-only patients, according to a May study in Medical Care Research and Review. The report also suggests that dual eligibles are twice as likely to become long-stay residents.

Often, duals have more complex health conditions and are more likely to lack resources — such as home equity — to enable non-institutional care. Being in a skilled nursing facility in the top 20% in terms of staffing, however, significantly narrows the gap between duals and Medicare-only patients when it comes to the likelihood of becoming a long-stay resident, according to the analysis. SNFs with high nurse staffing often specialize in the treatment of post-acute patients and may not be willing to treat dual-eligible patients for longer periods.

The analysis also showed that across all SNFs, duals' adjusted hospitalization rates were equal to or lower than Medicare-only rates. 

“Changes in the current SNF care referral process have the potential to reduce excess SNF utilization by dual-eligible beneficiaries and could help reduce spending by both Medicare and Medicaid,” the authors wrote.

Investigators analyzed about 907,000 hospital patients discharged to a SNF between 2008 and 2009, of whom 19% were dual eligible. Data came from sources such as the Minimum Data Set, Medicare enrollment and claims files.


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