Sometimes, it’s easy to get the impression that academics are trying heap things upon the skilled care sector. For every research paper that paints a positive picture of the field, it seems there are 10 more that focus on a less favorable aspect, from the nursing home’s side of things, be it the underreporting of antipsychotic prescriptions or alleged unnecessary rehab delivered at the end of life.
That’s why my ears always perk up when I hear about a study that takes the opposite tack and refuses to paint SNFs as the bad guy, or less skilled care as the solution to whatever ails a patient.
The latest example of the latter is a study recently released by researchers at the New York University School of Medicine. They’ve discovered that some SNF heart failure patients are actually being sent home too quickly, and that is leading to costly hospital readmissions.
Readmission risks could be as much as four times higher for patients discharged from a skilled care setting in two days or less. And that risk dropped by half among residents who remained in SNF settings for one to two weeks, NYU investigators found.
Some of our readers rightly seized on this data as a “duh” moment — as many in the business already know that slashing length of stay and rushing patients home, while probably cheaper for Medicare, isn’t always the best answer for patients in recovery.
“I’m astonished by this report. Who could have predicted cutting services would lead to worse outcomes? Truly amazing,” one McKnight’s reader sarcastically wrote.
Another reader went a little further, pointing out that health-maintenance organizations in California have crusaded to drastically reduce lengths of stay. Yet, it’s the SNFs who wind up punished when that patient who was rushed home winds up right back in the hospital. Given what NYU experts have spelled out here, maybe it’s time that HMOs start sharing some of the blame for costly readmissions?
Researchers suspect that one reason longer-stay heart failure patients are seeing better outcomes is because they’re getting extra time to recover, with more minutes dedicated to their new exercise regimen, diet and medications. Researchers believe that as much attention needs to be paid to planning discharge from the SNF as is paid to the same step when departing from the acute side.
“Current discharge plans for heart failure patients focus almost exclusively on patients leaving the hospital,” said study author, senior investigator and hospitalist Leora Horwitz, M.D., an associate professor of medicine and population health at NYU Langone. “However, to provide them with all-encompassing and better quality care, our study suggests it’s critical to start focusing these plans on the transition home from a skilled nursing facility as well.”
Authors seem to put the onus on hospitals to identify those heart failure patients with complex needs before they’re discharged, and create more individualized care plans prior to them making their way to a SNF. They next plan to conduct further research to help determine ways to improve current nursing facility discharge processes.
Until then, it seems like the prudent move is finding a seat at the table with your hospital partners to work out the particulars of each patient on the front end, rather than waiting until they leave your facility to figure out what went wrong.
Follow Staff Writer Marty Stempniak @MStempniak.
