Recent Studies Demonstrate Importance of Skilled Nursing Care in Reducing Hospital Readmissions
Washington, DC – As October 1st and the launch of the Hospital Readmissions Reduction Program draws closer, America’s skilled nursing centers have one message for the two-thirds of hospitals that soon face a penalty: we can be a valued partner in reducing your readmission rates. Recent studies and findings demonstrate more could be done to prevent avoidable rehospitalizations and reduce the threat many hospitals face under the Center for Medicare and Medicaid Services’ (CMS) new program.
Part of the Affordable Care Act, the Hospital Readmissions Reduction Program looks at the readmission rates among hospitals for specific conditions. Hospitals with above average readmission rates for those conditions will incur a penalty to their Medicare payments. A recent analysis from the Medicare Payment Advisory Commission (MedPAC) estimates that 67 percent of hospitals will face a penalty, with nine percent of hospitals expected to be penalized the maximum amount. MedPAC also estimated the average penalty for hospitals will be about $125,000.
“Health care is undergoing a massive evolution to where efficiency will be rewarded and quality will be king,” said Mark Parkinson, President & CEO of the American Health Care Association (AHCA). “This Hospital Readmissions Reduction Program is a prime example of the future of health care, and skilled nursing providers are the perfect partner to assist hospitals in reducing their rates. We can’t think in silos anymore, but as an entire delivery system, working together to increase quality care and reduce costs.”
Skilled nursing care centers are already preparing for the growing focus on reducing hospital readmissions as demonstrated by AHCA’s Quality Initiative launched earlier this year. Among the four goals the Association put forth was safely reducing hospital readmissions by 15 percent by March 2015. Roughly 20 percent of Medicare patients discharged from the hospital go to a skilled nursing facility (SNF) for rehabilitation care. Of these individuals, nearly one in four will be readmitted to the hospital within 30 days during their stay. If AHCA reaches its Quality Initiative goal, more than 26,000 individuals will avoid going back to the hospital from a SNF each year.
Other recent studies have also demonstrated the value and importance of skilled nursing care centers in serving individuals with specific care needs in order to prevent avoidable hospitalizations.
In a study published by HealthAffairs, researchers found that while Medicaid’s coverage of home and community-based services has increased over recent years, many of these beneficiaries were particularly vulnerable to avoidable hospital admissions compared to other Medicaid beneficiaries and the general population. The study also found that Medicare was paying for most of the cost associated with these hospital admissions among dual eligibles (individuals eligible for both Medicare and Medicaid) in home and community-based services. A second study commissioned by CMS, found that when considering a wide array of health care conditions, individuals using home and community-based services had higher avoidable hospital admission rates than nursing facility residents.
“We want individuals to be in the care setting of their choice, especially if that means in their own home or community. However, as these findings illustrate, there are certain conditions that skilled nursing centers are better equipped to handle. This is where America’s nursing homes can be the cost and quality solution,” continued Parkinson. “By being better suited for certain individuals, we can prevent sending those residents back to the hospital, improving their quality of life and also saving taxpayer dollars from additional, expensive care.”
For more information on the AHCA Quality Initiative, please visit qualityinitiative.ahcancal.org.
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the nearly 5 million seniors and individuals with disabilities who receive long term or post-acute care in our facilities each year. For more information, please visit www.ahcancal.org or www.ncal.org.