This blog post excerpts an article by Robin L. Rose, MBA, Vice President, Healthcare Resource Group, HealthStream, in the Q3 2015 issue of PX Advisor, our quarterly magazine designed to bring you thought leadership and best practices for improving the patient experience.
Studies have shown that there are a number of processes that occur during the inpatient stay and in the early stages of post-discharge care that do impact readmission rates. Most hospitals are focusing their improvement efforts in these areas. The following table identifies some of these common process breakdowns.
Research has shown that the density and quality of SNFs in a county has a significant impact on hospital readmission rates (Herrin, 2014). Roughly 40% of hospital inpatients are discharged to some type of post acute facility, with roughly half of these discharges going to a SNF (AHRQ, 2009). Recent analyses indicate that 23.5% of Medicare beneficiaries who are discharged from a hospital to a SNF are readmitted to the hospital within 30 days, at a cost to Medicare of $4.34 billion (Mor et al., 2010). Mor comments that, “These rehospitalizations have been shown to be frequent, costly, and often preventable,” (Mor et al., 2010).
To address the substantial impact that SNFs have on hospital readmissions, CMS is planning to roll out a readmissions reduction program targeting skilled nursing facilities. The Protecting Access to Medical Care Act of 2014 includes a value-based purchasing (VBP) program for SNFs. Beginning in October 2018, CMS plans to institute financial incentives that link Medicare payment rates to performance standards in order to hold SNFs accountable for their readmission rates. It is expected that the VBP program will provide a catalyst for SNFs to address long time staff turnover and development challenges and to seek better data sharing between hospitals, SNFs, and primary care providers.
Use of hospice and palliative care services during the last phase of life can greatly reduce the need for hospitalization during this time period. Research has shown that use of these end-of-life services can reduce hospitalizations in the subsequent 30 – 180 days by 40-50% and allow patients to spend on average 10 fewer days in the hospital during their last two years of life than those without such planning (Kowalski, 2015).
The challenge is that most patients who are discharged from the hospital fail to receive the education and planning necessary for end-of-life care. Studies have shown that there are low rates of referral for hospice and palliative care, although these services can lead to a substantially higher quality of life for the patients who receive this care. In 2012, an estimated 1.54 million patients received hospice services, up from 1.25 million in 2008 (NHPCO, 2013).
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