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The Growing importance of Performance Metrics Related to Care Transitions from Hospital to Skilled Nursing


The Q2 2016
PX Advisor is focused squarely on Non-Acute Care. This post excerpts an article featuring Al Litwiller, a national expert on long term care in the U.S.

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On Oct. 1, 2012, Medicare began penalizing hospitals that have high readmission rates. Depending on the region of the country, between 20 and 24 percent of patients are discharged to nursing homes. Of those patients, nearly 18 percent are readmitted to a hospital within 30 days. Reducing the rate of recidivism presents a significant opportunity for improvement. Now, as never before, hospitals have a powerful incentive to work closely with nursing homes to improve patient care, control costs, and reduce readmissions. Nursing home leaders know that the federal government’s commitment to value-based purchasing will likely reach their doorsteps in the not-too-distant future. In light of that, nursing homes are eager to demonstrate that they can work with hospitals to deliver high-quality care. 

With reimbursement at risk from readmissions, hospitals are eager to collaborate with nursing homes to enhance the discharge process, provide training, and take a longer-term look at the patient experience. For their part, forward-looking nursing homes are beginning to standardize protocols, re-emphasize individualized care plans, and tout positive quality rehabilitation programs to compete for hospital referrals.

Two Nursing Home Populations

Nursing homes serve two distinct populations—patients who need help recuperating before they return home and frail patients who will most likely live in the nursing home until they die. 

In 2015, the American Healthcare Association Fast Facts noted that nursing home residents that are termed short-stay are those having less than 100 days average length of stay. They comprise 22% of the nursing home population, whereas, long-stay residents have lengths of stay in excess of 100 days and comprise 78% of the nursing home population nationally. American Healthcare Association – Fast Facts, https.//www.ahcancal.org

The challenge for the nursing home is to continue to meet the needs of the 78% long-stay residents – typically the frail elderly - in a competent and compassionate manner, while gearing up to meet the needs of short-stay patients who are at the facility to receive rehabilitation services before returning home.

To apply even more pressure on the hospital-nursing home relationship and to draw a further distinction between the frail elderly and the short-stay patient, CMS has announced a plan which focuses on the short-stay Medicare Part A only. The short-stay population will be evaluated on the % of these short term stay patients (Medicare A) who are readmitted to a hospital within 30 days of admission to the nursing home.

Basic Performance Metrics in Long Term Care

The American Health Care Association (AHCA) is the largest and most respected long term care association in the nation. In conjunction with CMS, every 90 days AHCA releases nursing home inspection aggregate data by state to show trends and comparisons. Hospitals have several ways to assess the skilled nursing facilities to which they transfer patients.

There are several key metrics to consider when reviewing the CMS performance data.

  1. Inspection Violations

    Using Medicare Compare, hospitals can identify the names of all nursing homes who receive hospital discharged patients and review which violations each of those nursing homes are receiving each year.

  2. Occupancy Rates/Bed Availability

    Just as it is in the hospital’s best interest to make sure that the nursing home staff is clinically competent, it is also important to know where there is bed availability among the facilities in the hospital’s market area. Traditionally, an essential part of the discharge planning process has been for the discharge planner to be aware of bed availability for patients that are likely to be discharged to a nursing home facility.

  3. A Third Factor: Staffing Levels

    An third important factor in evaluating options for nursing home care involves an understanding of staffing levels at the facility. In other words, are staffing levels adequate to meet the needs of the residents?

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