The Skilled Nursing Facility 30-Day All Cause Readmission: What’s Next?

This blog post is an excerpt from one of the articles in our free eBook: A Closer Look at Readmissions and Medical Errors: What healthcare leaders should know about the industry-wide struggle.  

Hospitals, CMS and nursing homes have begun to take a closer look at the Transitions of Care (TOC) data, particularly that of hospital readmissions that occur within 30 days of discharge from an acute care hospital to a skilled nursing facility. Under Value Based Purchasing (VBP), a financial penalty is attached to poor performance on the hospital’s TOC measures which has led to more scrutiny on the causes of unscheduled readmissions, particularly those causes that may be beyond a hospital’s control. These readmissions are costly, put patients at risk for complications and appear to be largely preventable.

Readmissions: How Big Is the Problem?

The first thing to know is that the problem appears to be a fairly large one. CMS has used 2010 research to understand the size and complexity of the issue. Approximately one out of every four (23.5%) patients discharged from an acute care hospital to a SNF will be readmitted within 30 days. There are substantial differences in hospital readmission rates by state, ranging from a low of 15.1% (Utah) to a high of 28.1% (Mississippi). The readmission rates do not appear to be related to income as the state with highest median income (New Jersey) had a readmission rate that was somewhat similar to Mississippi’s (the state with the lowest median income).

However, facility characteristics do appear to be related to hospital readmissions. Nursing homes with the following characteristics have higher hospital readmission rates:

• Higher number of beds
• For profit facilities
• Free-standing facilities
• Facilities with a higher percentage of Medicaid patients

Not surprisingly, facilities with more hours per resident day of RNs, LPNs and CNAs have lower rates of readmissions. The financial cost of these readmissions also appears to be substantial. The average cost of each readmission is $10,352, and the total cost per year is a $4.34 billion dollars. Moreover; the data suggests that an overwhelming majority (78%) of the readmissions were avoidable, indicating that we are incurring a cost of $3.39 billion dollars for avoidable hospital stays. The SNF 30-Day All Cause Readmission measure is potentially very costly to SNFS. The financial penalties from CMS will likely be similar to those faced by acute care hospitals with higher than average 30-day readmission rates: up to 3% of Medicare reimbursements. The SNF data will be risk-adjusted. (Details about the risk adjustment calculation will likely be released in the next 12 months.) In addition, some patients will be excluded from the measure, including:

• Residents who are transferred to an inpatient rehabilitation facility
• Residents who are transferred to a Long Term Acute Care facility
• Residents who are discharged directly to home

There are additional exclusions for planned readmissions that happen within the 30-day period, residents who leave the SNF against medical advice, patients with specific DRGs (principally cancer and cancer related diagnoses), and patients who are readmitted for observation only.

This paper includes:

• The Rule - Skilled Nursing Facility Readmission Measure (Snfrm) Nqf #2510: All-Cause Risk-Standardized Readmission Measure
• Strategies for Reducing Readmission Rates
• Process Interventions: Every Time For Every Patient
• The Importance of Communication and Collaboration