Effect of Hospital–SNF Referral Linkages on Rehospitalization

Abstract

Objective To determine whether the rate of rehospitalization is lower among patients discharged to skilled nursing facilities (SNFs) with which a hospital has a strong linkage. Data Sources/Collection We used national Medicare enrollment, claims and the Minimum Data Set to examine 2.8 million newly discharged patients to 15,063 SNFs from 2,477 general hospitals between 2004 and 2006. Study Design We examined the relationship between the proportion of discharges from a hospital to alternative SNFs on the rehospitalization of patients treated by that hospital-SNF pair using an instrumental variable approach. We used distances to alternative SNFs from residence of the patients of the originating hospital as the instrument. Principal Findings Our estimates suggest that if the proportion of a hospital’s discharges to a SNF were to increase by 10 percentage points, the likelihood of patients treated by that hospital-SNF pair to be re-hospitalized within 30 days would decline by 1.2 percentage points, largely driven by fewer rehospitalizations within a week of hospital discharge. Conclusions Stronger hospital-SNF linkages, independent of hospital ownership, were found to reduce rehospitalization rates. As hospitals are held accountable for patients’ outcomes post-discharge under the Affordable Care Act, hospitals may steer their patients preferentially to fewer SNFs.

Incidence and Risk Factors for Unplanned Transfers to Acute General Hospitals From an Intermediate Care and Rehabilitation Geriatric Facility

“…15 The characteristics of our facility (eg, 24-hour availability of a specialist physician) and a very close and fluid functional relationship and coordination with the reference acute general hospital might explain the relatively few final admissions, as suggested by previous studies. 15,17 In particular, it highlights the lower readmission rates of European reports, including ours, compared with US data. This could partly be a consequence of differences between health systems.…”

Medicare Advantage Enrollees More Likely To Enter Lower-Quality Nursing Homes Compared To Fee-For-Service Enrollees

“…Previous work has found distance to be the principal factor influencing choice of SNFs. 35 We calculated the distance from the centroid of a beneficiary’s ZIP code to the SNF’s latitude and longitude using the haversine formula. 36 …”

“…12,13,35 From a given neighborhood (ZIP code), patients have a set of alternative SNFs (choice set) to choose from. In choosing a SNF, patients explicitly consider specific facility characteristics but also choose based on a general sense of the SNF, which may reflect other underlying characteristics.…”

“…In choosing a SNF, patients explicitly consider specific facility characteristics but also choose based on a general sense of the SNF, which may reflect other underlying characteristics. 12,13,35 Patients’ caregivers or providers may also make these decisions, based on different characteristics. Our goal was to assess how the influence of SNF characteristics on this selection differed between MA and FFS Medicare enrollees.…”

“…Based on previous literature, 12,13,35 we defined a choice set for each patient as all SNFs within twenty-two kilometers of the patient’s ZIP code, the fifteen closest SNFs, and any SNF that any other resident of that ZIP code selected. We fit a conditional logit regression model with each observation representing a patient choice.…”