The Revolving Door Of Rehospitalization From Skilled Nursing Facilities

Abstract

Medicare policymakers have recently become interested in changing the payment incentives around rehospitalizations. Using merged claims data, our analyses indicate 23.5% of Medicare beneficiaries discharged from the hospital to a skilled nursing facility (SNF) were directly readmitted within 30 days at a cost to Medicare of $4.34 billion in 2006. Although these results indicate significant potential savings, we also found that SNF rehospitalizations were heterogeneous in nature and varied considerably across local areas based on practice patterns. Medicare payment reform needs to account for incentives that vary geographically and by type of hospitalization in order to be effective.

Reducing Unnecessary Hospitalizations of Nursing Home Residents

“…Hospitalizations are common in this population; in 2006, 23.5% of the people admitted to a post-acutecare skilled-nursing facility were rehospitalized within 30 days. 1 Several studies suggest that many of these hospitalizations are inappropriate, avoidable, or related to conditions that could be treated outside the hospital setting -and they cost more than $4 billion per year. 1-3 Avoidable hospitalizations are also common among long-stay residents of nursing homes (see graphs).…”

Predictors of Hospitalization Among Newly Admitted Skilled Nursing Facility Residents: Rethinking the Role of Functional Decline

“…Functional decline, considered as geriatric syndrome, should be a particular focus for SNF clinicians to reduce the "revolving door" effect (transfers to and from the hospital). 4 These efforts could help to reduce Medicare-related financial burdens. Two studies about reducing the "revolving door" effect suggest the promising role of applying intensive rehabilitation therapy in functionally declining seniors in both acute hospital and post-acute care settings.…”

“…2 Reports show that one-fourth of SNF residents will return to the hospital within 30 days, 3 with an estimated cost of $14.3 billion in 2011. 4 That financial burden is then compounded by the added expenditure of transferring residents from SNF to the hospital. In total, 40% of hospital transfers from SNFs may be either unnecessary or avoidable, meaning that the resident could have been cared for safely at a lower level of care and at lower cost.…”

Implementing an evidence-based intervention to improve care for ventilator-dependent residents in a nursing home facility

“…[5] Readmissions from nursing home facilities to acute care hospitals are a critical health care issue, impacting both quality and safety for nursing home residents. Mor, et al [6] reported that in 2006 almost 25% of nursing home residents were readmitted to an acute care facility within 30 days of nursing home admission, at a cost of $4.34 billion. A more recent study conducted in 2011 by the Department of Health and Human Services reported similar readmission rates among Medicare nursing home residents, but found that the costs had tripled to $14.3 billion.…”