Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities

Abstract

Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries’ costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009–13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March–October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice.

Health information exchange between hospital and skilled nursing facilities not associated with lower readmissions

“…As such, implementing HIE to support transitions of care is rarely an isolated strategy. 15,19,20 However, even with other concurrent changes our study hospital may have made around the time of HIE rollout, our results suggest no overall beneficial treatment effect from these efforts. This null average treatment effect could, however, be muting beneficial impact for certain patient subpopulations in ways we are not well-positioned to detect.…”

“…Hospitals are facing increasing financial accountability for patients’ total cost of care and are tightening referral networks with select postacute providers, investing more selectively with these organizational partners in improved infrastructure and integrated handoff processes. As such, implementing HIE to support transitions of care is rarely an isolated strategy . However, even with other concurrent changes our study hospital may have made around the time of HIE rollout, our results suggest no overall beneficial treatment effect from these efforts.…”

“…SNFs face significant pressure to market themselves as willing collaborative partners in an environment where hospitals are increasingly looking to tighten their referral network and develop more integrated care practices. 16,19,20 While the evidence base demonstrating positive impact of HIE on cost and outcomes continues to grow, 21,22 there has been no empirical examination of whether HIE in the context of SNF transitions results in improved patient outcomes. This particular type of handoff merits special consideration, as information needs and organizational contexts differ substantially across these settings.…”

“…Further, facilities need to act strategically to maintain high occupancy, particularly in competitive markets. SNFs face significant pressure to market themselves as willing collaborative partners in an environment where hospitals are increasingly looking to tighten their referral network and develop more integrated care practices …”

Preferred Post‐Acute Care Providers in Bundled Payment: Implications for Patient Choice

“…Prior research found that, on average, hospitals discharged patients to more than 37 SNFs and 23 home health agencies . One response to the wide dispersion of post‐acute care discharges has been the establishment of “preferred networks” of SNFs or other post‐acute care providers by accountable care organizations and bundled payment awardees . In such networks, SNFs may agree to jointly implement care protocols, share information, and reduce length of stay in exchange for a higher volume of patients from the hospital or accountable care organization .…”