How Context Influences Hospital Readmissions from Skilled Nursing Facilities: A Rapid Ethnographic Study

Ayele, Roman; Manges, Kirstin; Leonard, Chelsea; Lee, Marcie; Galenbeck, Emily; Molla, Mithu; Levy, Cari; Burke, Robert E.

doi:10.1016/j.jamda.2020.08.001

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…Furthermore, because many potential predictors of improvement are not observable in our data set, complementary approaches to identify how SNFsparticularly those with low performance at baseline-were able to improve are needed. [21][22][23] The SNF VBP program is the first national value-based purchasing program in postacute care, but demonstration projects are also under way in other postacute settings, such as home health. 24 Comparing and contrasting findings in these programs may reveal important insights into valuebased purchasing design in postacute care.…”

Section: Discussionmentioning

confidence: 99%

“…Given the impact of the SNF VBP program on SNF finances, analyses identifying potential unintended consequences of the SNF VBP program on SNF financial performance (and related concerns, such as staffing and closures, which may affect patient access) are needed. Furthermore, because many potential predictors of improvement are not observable in our data set, complementary approaches to identify how SNFs—particularly those with low performance at baseline—were able to improve are needed …”

Section: Discussionmentioning

confidence: 99%

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Skilled Nursing Facility Performance and Readmission Rates Under Value-Based Purchasing

Burke

Rose

2022

JAMA Netw Open

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IMPORTANCEThe new Medicare Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) seeks to improve patient outcomes by awarding financial incentives or penalties based on 30-day hospital readmission rates. Skilled nursing facilities (SNFs) can avoid a penalty through low baseline readmission rates or improvement over time. OBJECTIVE To assess the baseline performance and improvement over time of SNFs in the SNF VBP program. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study examined readmission rates, financial penalties and incentives, and facility and patient characteristics associated with these outcomes at 14 959 US SNFs that received Medicare payments between January 1, 2015, and December 31, 2019.MAIN OUTCOMES AND MEASURES Outcomes were readmission rates and financial penalties by facility. The SNFs were classified as improvers in the analysis if they had better improvement scores than baseline scores under the program and achievers if they had higher baseline scores than improvement scores. RESULTSOf 14 959 SNFs studied, 1849 (12.3%) were assigned their improvement score as their performance score in the first year of the program. Of these, 1167 (63.1%) received a financial penalty, whereas 374 (20.2%) received a bonus. Only 52 facilities that performed poorly at baseline (0.3% of all SNFs and 0.7% of below-median performers) were able to improve enough to avoid a financial penalty, despite large improvements in readmission rates. Improver SNFs treated larger racial minority populations (mean [SD], 74.57% [23.42%] White in the improver group vs 79.15% [22.18%] in the achiever group) and were located in counties with larger minority populations (mean [SD], 15.48% [14.05%] Black in the improver group vs 11.57% [12.72%] Black in the achiever group). The most important predictors of improvement were related to SNF finances, such as operating margin (mean [SD], −0.74 [13.87]) and occupancy rates (mean [SD], 79.93 [14.81]). CONCLUSIONS AND RELEVANCEThis cross-sectional study suggests that the SNF VBP program did not offer a viable path for nearly all low-performing SNFs to avoid financial penalties through improved readmission rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Skilled Nursing Facility Performance and Readmission Rates Under Value-Based Purchasing

Burke

Rose

2022

JAMA Netw Open

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“…In all regression models, we adjusted for patient (age, sex, length of hospitalization, number of hospitalizations, ICU stay, history of ESRD, primary diagnosis, Charlson‐Deyo comorbidity score, Barthel Index, CFS), hospital facility (number of beds, medical school affiliation, ownership type, transplant capacity) and CLC facility (number of beds, rural/urban) variables. We included random effects for hospitals to account for potential variations in hospital transitional care processes 30,31 . In all models we used robust standard errors to adjust for clustering of observations within CLCs.…”

Section: Methodsmentioning

confidence: 99%

“…We included random effects for hospitals to account for potential variations in hospital transitional care processes. 30,31 In all models we used robust standard errors to adjust for clustering of observations within CLCs. Analyses were conducted in SAS version 7.1 (SAS Institute, Inc., Cary, NC).…”

Section: Statistical Analysesmentioning

confidence: 99%

VA nursing home compare metrics as an indicator of skilled nursing facility quality for veterans

Manges

Medvedeva

Ersek

et al. 2022

J American Geriatrics Society

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Background The Veterans Administration (VA) provides several post‐acute care (PAC) options for Veterans, including VA‐owned nursing homes (called Community Living Centers, CLCs). In 2016, the VA released CLC Compare star ratings to support decision‐making. However, the relationship between CLC Compare star ratings and Veterans CLC post‐acute outcomes is unknown. Methods Retrospective observational study using national VA and Medicare data for Veterans discharged to a CLC for PAC. We used a multivariate regression model with hospital random effects to examine the association between CLC Compare overall star ratings and PAC outcomes while controlling for patient, facility, and hospital factors. Our sample included Veteran enrollees age 65+ who were community‐dwelling, experienced a hospitalization, and were discharged to a CLC in 2016–2017. PAC outcomes included 30‐day unplanned hospital readmission, 30‐day mortality, 100‐day successful community discharge, and a secondary composite outcome of unplanned readmission or death within 30‐days of the hospital discharge. Results Of the 25,107 CLC admissions, 4088 (16.3%) experienced an unplanned readmission, 4069 (16.2%) died within 30‐days of hospital discharge, and 12,093 (48.2%) had a successful 100‐day community discharge. Admission to a lower‐quality (1‐star) facility was associated with lower odds of successful community discharge (OR 0.78; 95% CI 0.66, 0.91) and higher odds of a combined endpoint of 30‐day mortality and readmission (OR 1.27; 95% CI 1.09, 1.49), compared to 5‐star facilities. However, outcomes were not consistently different between 5‐star and 2, 3, or 4‐star facilities. Star ratings were not associated with individual readmission or mortality outcomes when considered separately. Conclusion These findings suggest comparisons of 1‐star and 5‐star CLCs may provide meaningful information for Veterans making decisions about post‐acute care. Identifying ways to alter the star ratings so they are differentially associated with outcomes meaningful to Veterans at each level is essential. We found that 1‐star facilities had higher rates of 30‐day unplanned hospital readmission/death, and lower rates of 100‐day successful community discharges compared to 5‐star facilities. Yet, like past work on CMS Nursing Home Compare ratings, these relationships were found to be inconsistent or not meaningful across all star levels. CLC Compare may provide useful information for discharge and organizational planning, with some limitations.

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Integration Activities Between Hospitals and Skilled Nursing Facilities: A National Survey

Burke

Phelan

Cross

et al. 2021

Journal of the American Medical Directors Association

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How Context Influences Hospital Readmissions from Skilled Nursing Facilities: A Rapid Ethnographic Study

Cited by 4 publications

References 31 publications

Skilled Nursing Facility Performance and Readmission Rates Under Value-Based Purchasing

Skilled Nursing Facility Performance and Readmission Rates Under Value-Based Purchasing

VA nursing home compare metrics as an indicator of skilled nursing facility quality for veterans

Integration Activities Between Hospitals and Skilled Nursing Facilities: A National Survey

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