Patients and hospitals often consult Nursing Home Compare data to figure out the best nursing facility to use following surgery. But a new study asserts that the data source is not a sound predictor of increased costs and complications that occur in skilled nursing facilities.
Researchers from three academic medical centers came to those conclusions after studying data from nearly 500 Medicare patients, residing in more than 100 SNFs taking part in bundled payment initiatives. They noted that Nursing Home Compare was not found to be a reliable predictor of costs, complications or readmissions in the three months following discharge.
“Given these findings and a lack of alternative rating tools for SNFs, CMS may consider expanding its rating system to more accurately adjust for staffing and quality measures, authors concluded in the analysis, published last month in the Journal of Arthroplasty. Conversely, they wrote, hospitals and surgeons might consider collecting outcomes data “to construct their own rating systems for SNFs used in their respective health system.”
Patients in the study were discharged to SNFs in 2017, following a total joint arthroplasty [TJA] procedure performed to restore joint function. Authors noted the importance of such cases, as they represent a large part of Medicare’s procedural costs, with volume expected to grow “substantially” in the next decade.
That has led the Centers for Medicare & Medicaid Services to make payment reform a priority, as evidenced in part by the introduction of its mandatory Comprehensive Joint Replacement bundle program. SNFs, they wrote, account for almost half of post-discharge payments, putting pressure on hospitals to pick the right partners, and SNFs to lower their costs.
Often, they turn to Nursing Home Compare, but the authors urged them to look elsewhere. Investigators noted that rates of 90-day readmissions or major complications did not differ significantly between 5-star-rated SNFs versus those with less than 4 stars. Patients were often given a list of SNF choices in alphabetical order, with little guidance as to how to choose, other than a link to the compare tool.
“Our results suggest an opportunity to refine and streamline Medicare NHC [Nursing Home Compare] to better enable hospitals/orthopedic providers to identify SNFs which provide the highest value care to patients after TJA,” authors wrote.