New research indicates incentives for clinician assessments of hospital-discharged skilled nursing facility patients should be strengthened.
At skilled nursing facilities, hospital-discharged patients who are not visited by a clinician are nearly twice as likely to be readmitted to a hospital as patients who receive visits, recent research shows.
About 20% of hospitalized Medicare patients are discharged to a skilled nursing facility (SNF). Readmissions have become a crucial metric for hospitals, with quality and financial dimensions. For example, Medicare has been penalizing hospitals financially for readmissions linked to several conditions such as pneumonia since 2012.
The recent study, published in Health Affairs and LDI Research Brief, found clinician visits to hospital-discharged patients at SNFs were strongly associated with readmission and mortality rates:
- SNF patients who received at least one clinician visit had a 14.3% hospital readmission rate. SNF patients who received no clinician visits had a 27.9% readmission rate.
- SNF patients who received at least one clinician visit had a 7.2% mortality rate. SNF patients who received no clinician visits had a 14.2% mortality rate.
The researchers examined data from more than 2 million Medicare fee-for-service SNF stays.
"Patients transitioning from hospitals to SNFs are often medically complex and at high risk of poor outcomes, with one in four of these patients deceased or re-hospitalized within thirty days. Results from this study suggest that missing and delayed care from physicians and advanced practitioners occurs during this vulnerable time," the study authors wrote.
Improving care at SNFs
Better incentives are needed to promote clinician assessments of hospital-discharged SNF patients, the researchers wrote. "Current regulatory and payment policies do not incentivize timely physician assessment of patients discharged from hospitals to SNFs. Medicare requires only that a physician complete an initial assessment within 30 days of SNF admission."
The lead author of the study, Kira Ryskina, MD, MS, told HealthLeaders that some new payment models are promoting enhanced SNF care. "Payment reform such as bundled payments that penalize hospitals for their patients' postacute care outcomes aim to encourage hospitals to invest more resources in SNFs."
Medical assessments of patients at SNFs generally feature three elements, she said.
"Typically, an effective assessment has an admission history including a review of medical records from the preceding hospitalization and medication reconciliation, physical examination, and delineation of plan of care," said Ryskina, an assistant professor of medicine at the University of Pennsylvania's Perelman School of Medicine.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
About 20% of hospitalized Medicare patients are discharged to a skilled nursing facility.
Hospitalized patients discharged to SNFs are vulnerable in the first 30 days after leaving a hospital.
Clinician assessments of hospital-discharged SNF patients generally include a hospital-admission history, physical examination, and care plan delineation.