The last couple of years have seen lots of attention on the readmission rate of Medicare beneficiaries following a stay in a hospital. But what about readmission rates from post-acute facilities? Two recent studies have found that the readmission rate for residents of skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) is about the same as it is for hospitals. To reduce the rates of readmission, and hopefully improve care, the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) implemented payment reductions for hospitals that do not meet specific readmission rate targets, and will use hospital readmission rates for IRFs as a national quality indicator.
Readmissions After SNF Discharges
The readmission rate of SNF residents in North and South Carolina was about 22 percent, according to a recent study reported in the Journal of the American Geriatrics Society. The study found that “within 30 days of SNF discharge to home 10.3% (5,771 unique participants) had ED visits without hospitalization and 14.7 % (8,303 additional unique participants) were rehospitalized.” During the period from January 1, 2010 to August 31, 2011, 12, 349 visits were made to hospitals by SNF residents within 30 days of being discharged from a SNF; this number is slightly higher than the unique participant number because some residents had more than one hospital visit during the 30 days following discharge from the SNF.
The majority of hospital visits happened very soon after discharge from the SNF. The study found that 12 percent of SNF residents had a visit to a hospital’s emergency department or were rehospitalized within 10 days of being discharged. On an upbeat note, only 4,538 of the 55,980 Medicare beneficiaries studied or 8.1 percent died within 90 days of being discharged from a SNF.
Residents of IRFs had a readmission rate of 18.8 percent during the 30 days following discharge, according to a second study reported in the Journal of the American Medical Association. The study examined 736,536 Medicare beneficiaries who were discharged from 1,365 IRFs between 2006 and 2011. Mirroring the finding of the SNF study, most readmission following discharge from an IRF happened soon after discharge. “Approximately 50 percent of patients hospitalized within the 30-day period were readmitted within 11 days of discharge,” the study found.
Readmissions After Hospital Discharge
The readmission rate to hospitals within 30 days of discharge has been in the 18 to 19 percent range since 2007. The Kaiser Family Foundation reports that during the first 8 months of 2013 the hospital readmission rate fell below 18 percent. In 2012, the readmission rate was 18.5 percent and from 2007 to 2011 it had been 19 percent each year.
The Hospital Readmission Reduction Program (HRRP) began assessing reductions in payments to hospitals that did not achieve their readmission goal beginning with payments for calendar year 2013. In the first year of the program 2,213 hospitals were fined for not meeting their readmission rate goals. In the second year of the program 2,225 hospitals were penalized for not meeting their goals. Penalties in the first year could have been as high as 1 percent and a 2 percent reduction was applied during the second year. A reduction as much as 3 percent could apply during the third year of the program. Only a small number of hospitals are receiving the full reduction. Of the 2,225 hospitals receiving a reduction in 2014, only 18 are received the full 2 percent reduction and another 154 will be receiving a 1 percent reduction. The majority of hospitals that are receiving a reduction in 2014 will be receiving a reduction of less than 1 percent. Kaiser said that the total reduction will result in a loss of $227 million to all hospitals in 2014.
CMS has stated that rehospitalization can be a sign of low-quality care and it has been taking action with hospitals to help drive down the rate of readmissions to a hospital. These studies show that the post-acute care settings of SNFs and IRFs have a readmission rate similar to hospitals, which might lead one to wonder if similar carrot and stick incentives will be applied to these facilities to drive down the rates of readmission to a hospital following discharge.