Local Post-Acute Care Resources Tied to Hospital Readmissions, Pay

Hospitals that had more local access to post-acute care services, such as primary care physicians and skilled nursing facility (SNF) beds, had lower thirty-day hospital readmission rates compared to hospitals that had limited local supply, according to a new study published in Health Affairs.

Hospital-run palliative care services and a greater local supply of licensed nursing home beds were also associated with lower thirty-day hospital readmission rates, a key factor in value-based incentive payment programs.

CMS provides incentive payments to Medicare hospitals that have lower thirty-day readmission rates through the Hospital Readmissions Reduction Program (HRRP). However, if hospitals fail to reduce their readmission rates to or under a target rate given by CMS, then hospitals in the mandatory HRRP receive a financial penalty in the form of reduced future Medicare reimbursements.

Since 2010, reducing hospital readmissions has been a major goal for hospitals because of the incentive payments CMS has tied to the metric. The HRRP reflects differences in hospitals’ volume, case mix, and patient-level risk factors for readmission, such as age, sex, and clinical morbidities, to ensure fair target rates for hospitals. More recently, CMS has also stratified hospitals into peer groups based on a facility’s proportion of patients dually eligible for Medicare and Medicaid. Treating a higher proportion of dually eligible patients has been linked to a higher readmission rate.

But new data also shows that availability of post-acute care services in a hospital’s community is also linked to how many readmissions they will see within 30 days of patient discharges.

The Health Affairs study analyzed nationwide panel data on hospitals, which accounted for multiple factors that may confound the relationship between post-discharge care supply and readmissions, including demographics, hospital characteristics, and value-based payment program incentives.

Researchers found that greater availability of certain local post-acute care services helped hospitals do better with thirty-day readmissions after hospitalizations for acute myocardial infarction, heart failure, and pneumonia.

Overall, hospital readmission rates were negatively associated with per capita supply of primary care physicians (−0.16 percentage points per standard deviation) and licensed nursing home beds (−0.09 percentage points per standard deviation).

In contrast, greater access to nurse practitioners after hospitalizations for the three conditions was linked to higher readmission rates. Overall, readmission rates were positively associated with per capita supply of nurse practitioners (0.09 percentage points per standard deviation), the study showed.

Researchers explained that hospitals in areas with more local availability of nurse practitioners and even home health agencies may experience higher readmissions because of frequent staffing changes and resulting discontinuities of care.

With post-acute care resources now linked to readmission rates, and therefore Medicare payments, researchers advised hospitals to “take a more active role in the development of post-discharge care options in their communities or partner with existing infrastructure to improve continuity of care and clinical outcomes and to avoid penalties under the HRRP.”

“If not already doing so, hospitals should track readmission performance by discharge site and see whether there are opportunities to improve quality of care and lower readmission rates through reengineered discharge planning,” study authors also wrote.

Additionally, they suggested potential changes to the HRRP to account for local healthcare system characteristics when determining what hospitals receive penalties for higher readmission rates. Many hospitals already operate in underserved areas and simply do not have the post-acute care resources available to their patients.

“Hospitals in these underserved areas could experience higher thirty-day readmissions if they were unable to make referrals to adequate post-discharge care in their communities,” study authors stated.