A nurse works at a computer

A new study calls for updating the tools used to assess hospital readmission risk for skilled nursing facility (SNF) residents.

One of the measurements used to assess a SNF’s quality of care is how many people are readmitted to an acute care hospital within 30 days of being placed at the SNF. The current study concludes that using “clinically validated” readmission risk assessment tools instead of the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) risk adjusters being used could help more accurately understand illness severity when payments are adjusted. The study was published on Tuesday in the Journal of the American Geriatrics Society.

Researchers looked at medical records covering 13,810 admissions and discharges between 2014 to 2019 at two teaching hospitals, and readmissions from a single 252-bed facility. The mean patient age at hospitalization was 79.2 years old. One-third of the people in the study were over the age of 85, and most were females. 

The researchers pinpointed data on people who were in the SNF and readmitted to the hospital within 30 days. In total, 2,408 people were readmitted to hospitals between 2014 and 2019.

Then the team calculated the LACE, Charlson comorbidity index (CCI) and simplified HOSPITAL scores for the study years on all participants. Those scores are proven and validated to predict a person’s risk of readmission and 10-year mortality based on their illness. The data showed that the mean yearly score of all three indices rose steadily. 

There weren’t any significant findings in terms of odds of readmission related to the CCI score and 30-day readmission risk, but there was an association between LACE and HOSPITAL scores and 30-day readmission risk. 

“Our study suggests that the use of clinically validated readmission risk assessment tools instead of the SNF VBP current risk adjusters may be a more accurate reflection of the current illness severity of a facility’s patient population at the time of payment adjustment,” the authors wrote. 

“Consideration of adding the simplified HOSPITAL score to LACE and CCI scoring adds a risk assessment tool that includes two lab values, hemoglobin and sodium levels, in the scoring rubric and may enhance benchmarks used to measure SNF performance, reimbursement and/or penalties,” the authors added. 

If the Centers for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Readmission Measure (SNFRM) continues to serve as a metric in the SNF VBP, more studies need to determine national benchmarks for SNF 30-day readmission rates based on how sick people are. 

An SNF admitting patients with higher LACE and HOSPITAL scores should have a different benchmark than a facility admitting lower-scoring patients, the authors wrote.

“Multiple studies have demonstrated that the current achievement/ improvement score methodology of calculating SNFRM performance does not adequately reflect an SNF’s quality,” the authors wrote.