Post–Acute Care Reform: Implications and Opportunities for Hospitalists

Abstract

Nearly all practicing hospitalists have firsthand experience discharging patients to post–acute care (PAC), which is provided by inpatient rehabilitation facilities, skilled nursing facilities, or home healthcare providers. Many may not know that PAC is poised to undergo transformative change, spurred by recent legislation resulting in a range of reforms. These reforms have the potential to fundamentally reshape the relationship between hospitals and PAC providers. They have important implications for hospitalists and will open up opportunities for hospitalists to improve healthcare value. In this article, the authors explore the reasons for PAC reform and the scope of the reforms. Then they describe the implications for hospitalists and hospitalists' opportunities to Choose Wisely and improve healthcare value for the rapidly growing number of vulnerable older adults transitioning to PAC after hospital discharge.

Nurses' Role in Managing “The Fit” of Older Adults in Skilled Nursing Facilities

“…Table 2 presents providers' years of experience, and Table 3 reports nurses' characteristics. The patient and caregiver analysis is reported elsewhere (Burke et al, 2017). Health professionals who participated were physical therapists, occupational therapists, nurses, social workers, case managers, physicians, and NPs.…”

“…In many ways, SNFs currently function as if they are hospital step-down units, but are not staffed to provide this level of care. The addition of a clinician with prescribing and decisionmaking authority on-site who can see patients as often as required adds a layer of safety and monitoring for high-acuity facilities (Burke et al, 2017;Ingber et al, 2017;Intrator, Zinn, & Mor, 2004;Unroe et al, 2015). This addition may be required if a recently proposed rule change by the Centers for Medicare & Medicaid Services requiring an in-person evaluation of a nursing home resident before transfer to the emergency department is put into action (Katz, Resnick, & Ouslander, 2015).…”

“…Hospital readmissions are often preventable and costly (Levinson, 2014), and thus have been the target of legislation to align payments to incentivize providers to improve the quality and safety of transitions (Burke, Cumbler, Coleman, & Levy, 2017). These recent legislative reforms enforce greater levels of accountability for hospitals and SNFs for the costs and outcomes of care.…”

Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care

“…Emerging payment reforms are sharpening focus on patient selection for SNF and on outcomes such as readmissions, rates of discharge back to the community, and costs. 2,3 Despite the national focus on post-acute care brought about by legislation, relatively little is known about how hospitalized older adults and their caregivers decide whether to go to a SNF for post-acute care. Published studies have focused on the content of the information presented, rather than trying to assess the decision-making process 4,5 or on caregivers who recently placed a family member in a long-term care facility from home, rather than inpatients going to post-acute care.…”

Predicting Potential Adverse Events During a Skilled Nursing Facility Stay: A Skilled Nursing Facility Prognosis Score

“…Such a model also has the potential to differentiate between individuals at low risk of a potentially adverse outcome (who may require less intensive monitoring and treatment) and those at high risk (who may be at such high risk they require intensive intervention or involvement of palliative care). 5,7 Therefore, we sought to develop a model that could be used to predict potential adverse outcomes in previously community-dwelling Medicare beneficiaries being discharged from the hospital to a SNF using information that would be available around the time of SNF admission.…”