Hospitals with a greater local supply of skilled nursing facilities and licensed nursing home beds are less likely to readmit patients with key conditions than hospitals in areas that lean heavily on home care networks, new research shows.

A higher concentration of nursing home beds was associated with a lower 30-day readmission rate for Medicare patients treated for myocardial infarction, heart failure or pneumonia, according to a Health Affairs study published today. Those are the three conditions targeted by the federal Hospital Readmissions Reduction Program, which penalizes providers with higher-than-average readmissions.

Researchers at the Veterans Affairs Boston Healthcare System theorized that patients with poor access to outpatient medical follow-up might be readmitted more often, especially if their hospitals couldn’t make convenient or timely referrals for optimal post-acute care.

Their review of related conditions from more than 3,000 hospitals between 2013 and 2019 found readmissions were lower at hospitals that operated a palliative care service or had a greater supply of SNF beds or primary care physicians. Conversely, having more home health agencies and nurse practitioners in the local area was associated with an increase in readmissions for the key conditions.

“Our results suggest that hospitals may take a more active role in the development of postdischarge care options in their communities or partner with existing infrastructure to improve continuity of care and clinical outcomes and to avoid penalties under the HRRP,” the researchers wrote. “Palliative care use may reduce unwanted, potentially unnecessary medical care for seriously ill people, whereas patients in areas without sufficient access to primary care or nursing facilities (for example, isolated rural or low-income urban areas) may be forced to return to hospital emergency departments if complications arise.”

Kevin Griffith
Kevin Griffith

A nursing home offering palliative care would be a “double bonus,” in terms of reducing readmissions, lead author Kevin Griffith, PhD, told McKnight’s Long-Term Care News Tuesday. Griffith is an investigator at the Partnered Evidence-based Policy Resource Center at the Boston VA and an assistant professor of health policy at Vanderbilt University Medical Center.

Co-authors included David Schwartzman of Washington University in St. Louis; Steven Pizer and Melissa M. Garrido of the Veterans Affairs Boston Healthcare System and Boston University and Jacob Bor, Vijaya B. Kolachalama and Brian Jack of Boston University.

A healthy continuum that offers a range of care services remains critical for hospitals looking to discharge patients with key diagnoses, Griffith said. He noted that hospitals with an overreliance on home care may be susceptible to variations in both supply and quality of care given frequent staffing changes.

The researchers recommended hospitals track readmission performance by discharge site to see whether there are opportunities to improve quality of care through better planning. Skilled nursing operators could seize on the findings with hospital partners, illustrating the likelihood that, at least for certain conditions, they remain a key partner in improving outcomes and preventing penalties.

“There’s a large amount of money on the table for hospitals, but it’s also an important patient-centered outcome,” Griffith said. “Nobody wants to go to the hospital. The only thing worse than going to the hospital is having to go back for the same condition.”

Skilled nursing providers are also under the gun to help their patients avoid readmissions; penalties kicked in for the sector’s worst performers starting in 2018.