When doctors suggested in 2009 that nursing homes and hospitals might be guilty of inadequate coordination of care and poor discharge planning, resulting in the rehospitalization of about half their patients within 30 days, nursing facilities were quick to take up the gauntlet, revising their programs to meet the challenge.
An example is Revera Health Systems, which includes 30 skilled care centers across the United States offering subacute and short-stay rehab care, as well as long-term care.
Brian Karstetter, regional VP of operations for Revera, has this to say in an article printed on the Web:
“The ‘revolving door’ of rehospitalization from nursing facilities is a growing problem in the U.S. A study conducted by the Medicare Payment Advisory Committee found that up to two-thirds of these readmissions are unnecessary and avoidable, with potentially serious health risks for patients — and significant financial implications for both hospitals and nursing facilities.
In 2010, researchers at Brown University examined the frequency of patient readmissions from skilled nursing centers. Karstetter writes: “They focused on Medicare recipients who were transferred from a hospital to a nursing home and rehospitalized within 30 days of discharge. The study found that readmission rates increased by 29% between 2000 and 2006. In 2006, Medicare expenditures for rehospitalized patients totaled $4.3 billion. Today, that cost is closer to $17 billion.
“Numbers like these tend to get the attention of government policymakers, and with health care reform on the minds of legislators and consumers alike, the issue of rehospitalization has come under close scrutiny. “
“The Patient Protection and Affordable Care Act of 2010 specifically addresses the problem, and starting in 2013, allows Medicare to levy financial penalties for hospitals based on readmission rates,” Karstetter cautions.
Medicare is also considering “pay for performance” incentives and new payment models for hospitals that may require changes in how hospitals make discharge decisions.
There are fiscal threats for hospitals and nursing homes as well. As a result of health care reform legislation, hospitals with higher-than-average rates of readmission may soon face financial penalties. The Patient Protection and Affordable Care Act allows the Center for Medicare and Medicaid Services (CMS) to withhold a percentage of inpatient Medicare payments based on a hospital’s aggregate Medicare payments for all discharges. In today’s economy, no hospital can afford such losses.
And there’s a reputational cost to rehospitalization as well. High readmission rates imply poor quality of care, communication and coordination, and can have a negative effect on an institution’s image and ability to attract patients. For all these reasons, a growing number of health care executives and analysts are working to develop systems and policies that will reduce readmission rates.
Blue Sky Therapy is known for 28 years of resident-centered care. We’re a therapist-owned provider of contract rehabilitation services, and we have set the standard in the rehabilitation industry, providing physical, occupational, and speech therapy to residents and our partners.