Despite major disruptions to healthcare during the pandemic, nearly one-fifth of skilled nursing patients continue to be readmitted to hospitals, a Centers for Medicare & Medicaid Services researcher said Wednesday.
Also persisting were disparities among patients when it came to who was most likely to be referred to skilled nursing and then need a hospital stay, said Jess Maksut, PhD, technical director of the CMS Office of Minority Health.
Her comments came during the CMS Health Equity conference being hosted at Howard University in Washington, DC, this week. Maksut’s study reviewed characteristics of more than 300,000 Medicare Fee-For-Service patients who had an index (in) hospital stay for one of six core conditions between March 2020 and October 2022. The goal was to discern whether the pandemic had shaken loose any long-standing trends.
“We were really curious to see what this population looked like relative to individuals for discharge-to-home or other settings, and we wanted to understand whether and what factors were associated with readmission among individuals who are discharged to SNFs in particular,” said Maksut, who noted readmission rates have long hovered around 20%.
Those referred to skilled nursing in her dataset were overwhelmingly white (80%), with 78% residing in a metropolitan area. Nearly all the individuals (98.4%) discharged to nursing homes also had four or more co-occurring health conditions
“Individuals who are discharged to SNFs are sicker or more medically complex than individuals discharged to other settings,” Maksut observed. “In terms of who has seven or more co-occurring health conditions, it’s much higher in those that were discharged to SNFs.”
That of course could contribute to the need for rehospitalization, which has been the only metric included in the SNF value-based purchasing plans for the last several years. CMS recently announced a proposal to refine the measure for nursing homes.
But questions remain about why nursing home residents are more likely to be referred back to the hospital than those cared for in other settings. Maksut’s research uses data to help interpret the role of characteristics such as age and condition, or whether hospital and nursing home characteristics or unknown biases might also contribute.
“Those 300,000 or so individuals that had been discharged to SNFs after their index hospitalizations, we saw that that readmission rates were significantly higher than readmission rates [in] other settings,” she said. “About 17% of individuals discharged to SNFs were readmitted after their index hospitalization within that 30-day time frame. That was about 11% for individuals discharged elsewhere.”
And when it came to race and ethnicity, Maksut said her team saw that among individuals sent to nursing homes and those sent elsewhere, readmission rates were highest among Black patients. In skilled nursing, about 21% of those patients required an additional hospitalization within 30 days.
Maksut said some of the racial and ethnic nuances not captured in her study would be good for further examination, given CMS’ focus on improving equity across the care continuum.
“Disparities did not look any different than they looked pre-pandemic. They were just as large, just as stark,” she said. “There is much more work to do to address these disparities, including disparities across race and ethnicity groups, across dual-eligibility status groups, and others. Gaps continue to need to be closed. This is true for those discharged to SNFs and those discharged elsewhere.”