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Top Reasons for Hospital Readmissions from SNFs

When it comes to hospital readmissions, there’s a fine line between being cautious and being careless. One in five elderly persons is readmitted to the hospital within 30 days of leaving, according to the federal government. Not only is this a disconcerting fact for the patients’ sake, but also financially destructive.

Hospital readmissions from Medicaid patients alone cost the government $26 billion annually, according to the Robert Wood Johnson Foundation. Worse yet, $17 billion of that cost could have been avoided if patients received proper care the first time.

What are common reasons for hospital readmissions?

Patients aren’t well informed

Oftentimes, patients aren’t informed how their care will or should be transitioned once they’re admitted into a post-hospital facility. This leaves them unaware of what to expect and what to identify as appropriate or inappropriate care. It’s clearly important for doctors across the facilities to communicate and be aware of next steps, but the patient needs to be aware as well.

Even upon discharge, patients usually are not communicated with enough. Typically they don’t fully understand the extent of their conditions and the expectations of future treatment processes. They may even be advised to focus on treating one illness while others that are equally important remain ignored.

Just as patients aren’t informed well enough, typically their families aren’t either. Patients’ families are frequently the ones providing care at home or ensuring the care remains on track and need to be valued as a vital piece of the process.

Hospital inconsistencies

Certain hospitals are proving more likely than others to result in readmissions. This unveils a major inconsistency of care and lacking standards across the country. Care is expected to start at the hospital and be completed at the SNF. If the first part of that process is subpar, it can set the SNF up for failure.

Lacking collaboration

Currently, there is very little financial incentive for hospitals, SNFs and other facilities to coordinate care with one another. This lack of collaboration, along with many other inefficiencies, results in poor communication across the organizations, inappropriate placing of patients and, ultimately, increased rehospitalizations.

Studies have shown that increased collaboration can aid in lowering hospital readmissions. With all providers communicating to understand the patient’s condition, areas of concern and a proper treatment plan, they’re able to join together to provide an enhanced level of care.

Another aspect of the lacking incentive for collaboration is due to regulations being largely unenforced.

Unenforced regulations

In 2013, the Hospital Readmission Reduction Program (HRRP) was established as part of the Accountable Care Act (ACA). The program’s main initiative was to penalize hospitals with relatively high readmission rates. In its premier year, the penalty fee was set at 1% with the fee set to increase by an additional 1% for each consecutive year, until reaching 3% in 2015.

Ultimately, this fine reduces the hospital’s reimbursements from health care payors. For many facilities, the fee has already made a substantial financial impact.

Now in 2015, hospital penalty fees have increased year over year but the average penalty remains below 1%, despite the 3% fee cap. The HRRP hospital penalties total is expected to reach $428 million this year, despite the lower percentage fee average being implemented. Why? More hospitals are failing to meet the lower readmission regulations, with 78% receiving a penalty this year compared to 64% last year.

Elderly patients require more medical attention

Patients naturally require more medical care with age. Because Medicare and nursing homes are providing care during these later life stages, certain hospitalizations are simply unavoidable. Typically, the outcome of elderly patient care depends on the availability of services and equipment, practice standards in the area, and the opportunity and willingness to use hospice.

Availability of trained MDs and NPs

As the majority of doctors continue to age, the physician shortage is expanding across the nation. Not only are physicians limited, but many of those who do provide care at SNFs only do so on a part-time basis.

A doctor’s time is typically divided between his own private practice, the hospital and nursing homes; this leaves his time spread too thin to provide the highest quality care. As another downfall, “Sometimes an RN concerned about a patient calls a physician group and reaches a doctor who doesn’t know the nursing home,” says Ken Scott, MD, corporate medical director of Life Care Centers of America.

Medication discrepancies

Of 2,319 medications reviewed, 495 (21.3%) had a discrepancy, according to research conducted at two community-based SNFs within long-term care facilities. On a broader scale, in 142 of 199 observed SNF admissions, at least one medication discrepancy was found—meaning 71.4% of medications had errors.

Without physicians and pharmacists readily available at SNFs, RNs and LPNs are left performing medication reconciliation. With these tasks being improperly delegated and poorly communicated, the risk of medication errors is drastically heightened.

Lack of proactive care

Many SNF physicians follow a reactive approach and simply treat problems as they arise. But, taking proactive measures and regularly meeting with patients before a problem occurs ensures those issues are eliminated all together. Patients need to understand that caring for their own health is important each and every day, not only when sickness occurs or procedures are required. Regular checkups have the potential to pinpoint factors that can be contained and should be highly encouraged.

Improper discharge

The Office of Inspector General (OIG) has identified that many patients from nursing homes, including SNFs, are improperly discharged. In an OIG-conducted study, 31% of SNF stays did not meet discharge requirements. Discharge planning requires a written summary of the patient’s stay, his or her current condition and next steps in the care plan. Accuracy of this summary is important to ensure patients are being seamlessly transitioned into another setting.

As hospital readmission penalties continue to increase, now is the time to make adjustments. Having a full-time SNFist at SNFs provides better access to care for patients, more informed decision-making capabilities and an overall increase in the quality of care.

General Medicine, The Post-Hospitalist Company partners with your facility to implement a customizable care program. Our post-hospitalists have unparalleled expertise in post-acute care and help your facility achieve better care quality and regulation compliance, and avoid the many common reasons for hospital readmissions.

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Tom Prose
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