Trends in hospital-SNF relationships in the care of Medicare beneficiaries

Liao, Joshua M.; Konetzka, R. Tamara; Werner, Rachel M.

doi:10.1016/j.hjdsi.2018.05.001

Cited by 8 publications

(6 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…26 Other studies suggest weakening hospital-SNF relationships over time. 27 Finally, as hospitals presumably move toward home-based care and more selective SNF referrals, evidence is needed to understand how this affects competitive pressures for SNFs. The extent to which SNFs not in preferred networks, for example, are downsizing or facing closures—and which ones are most sensitive to these pressures—will be important to monitor.…”

Section: Discussionmentioning

confidence: 99%

Hospitals Using Bundled Payment Report Reducing Skilled Nursing Facility Use And Improving Care Integration

Zhu¹,

Patel

Shea

et al. 2018

Health Affairs

Self Cite

View full text Add to dashboard Cite

A goal of Medicare's bundled payment models is to improve quality and control costs after hospital discharge. Little is known about how participating hospitals are focusing their efforts to achieve these objectives, particularly around the use of skilled nursing facilities (SNFs). To understand hospitals' approaches, we conducted semistructured interviews with an executive or administrator in each of twenty-two hospitals and health systems participating in Medicare's Comprehensive Care for Joint Replacement model or its Bundled Payments for Care Improvement initiative for lower extremity joint replacement episodes. We identified two major organizational responses. One principal strategy was to reduce SNF referrals, using risk-stratification tools, patient education, home care supports, and linkages with home health agencies to facilitate discharges to home. Another was to enhance integration with SNFs: fifteen hospitals or health systems in our sample had formed networks of preferred SNFs to exert influence over SNF quality and costs. Common coordination strategies included sharing access to electronic medical records, embedding providers across facilities, hiring dedicated care coordination staff, and creating platforms for data sharing. As hospitals presumably move toward home-based care and more selective SNF referrals, more evidence is needed to understand how these discharge practices affect the quality of care and patient outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Hospitals Using Bundled Payment Report Reducing Skilled Nursing Facility Use And Improving Care Integration

Zhu¹,

Patel

Shea

et al. 2018

Health Affairs

Self Cite

View full text Add to dashboard Cite

show abstract

“…Anxiety and depression experienced by people with diabetes who live in urban areas cannot be separated from the factors of work and wages earned. It is because their income was not sufficient to fund periodic hospital treatment, as well as the costs involved in having to go for further treatments or expensive hospitalization [ 49 - 51 ]. Therefore, they prefer to do a traditional treatment at home, which cannot give reassurance that the disease has been cured.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of the Effects of Anxiety and Depression on People with Type 2 Diabetes Mellitus: An Analysis of Health Policy Studies in Improving the Quality of Life of Poor Families in the Urban Areas of West Lombok, Indonesia

Nasirin

Lionardo

2020

CDR

View full text Add to dashboard Cite

Background: To explore the tendency of the effects of anxiety and depression that occur in type 2 diabetes patients, especially poor patients who live in the urban areas with poor economic conditions, who do not have health access from the government, and live very far from the hospitals. Methods: The study design used in this study was cross sectional which aimed to determine the number of patients who experienced anxiety and depression problems due to the declining health conditions caused by diabetes. A sample size of 98 diabetics experienced anxiety and depression when the treatment was carried out. The study design used was included into a qualitative study with in-depth interviews with respondents who were at risk of diabetes, as well as to determine the level of anxiety and depression that occured when medical care was carried out and the feelings experienced by the respondents after completion of treatment. Results: Diabetic patients are generally unaware that their illness is a chronic disease that takes a long time to treat. When the patients are sick, most of them do not immediately go to the hospital or a specialist for having their health examination and treatment, because the hospital is far from the patients’ residence. Furthermore, some patients still use traditional medicine and non-medical treatment, so when the patients with critical conditions are taken to the hospital, they already suffer from chronic diabetes. Conclusions: The lack of access to health for chronic patients with poor economic conditions who live far from the hospitals and the scarcity of medical staff to carry out socialization and treatment of chronic diseases such as diabetes for poor patients in urban areas certainly have an impact on the high number of patients of chronic diseases. Therefore, the government is expected to be able to provide easy health policies to remote rural communities in order to achieve optimal community welfare and health.

show abstract

“… 1 , 2 Financial pressures associated with moving from fee-for-service reimbursement toward bundled payments and population-based payment models, as well as evolving referral patterns, have all been implicated. 3 , 4 The shifting of financial risks has also motivated integration of hospitals with post–acute care facilities, 5 , 6 , 7 , 8 which can include policy-inspired formal arrangements, preferred provider networks, or vertical integration. In 2015, 80% of hospitals owned at least 1 post–acute care service, with 33% owning a skilled nursing facility (SNF).…”

Section: Introductionmentioning

confidence: 99%

“…9 Vertical integration of SNFs will continue to play a growing role as health care networks strategically acquire these facilities and hospitals gain exposure to these facilities upon joining a network. 7,10 The impact of vertical integration of SNFs on outcomes, utilization, and costs remains unclear.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Skilled Nursing Facility Ownership by Health Care Networks With Utilization and Spending

et al. 2023

View full text Add to dashboard Cite

ImportanceHealth care mergers and acquisitions have increased vertical integration of skilled nursing facilities (SNFs) in health care networks. While vertical integration may result in improved care coordination and quality, it may also lead to excess utilization, as SNFs are paid a per diem rate.ObjectiveTo determine the association of vertical integration of SNFs within hospital networks with SNF utilization, readmissions, and spending for Medicare beneficiaries undergoing elective hip replacement.Design, Setting, and ParticipantsThis cross-sectional study evaluated 100% Medicare administrative claims for nonfederal acute care hospitals performing at least 10 elective hip replacements during the study period. Fee-for-service Medicare beneficiaries aged 66 to 99 years who underwent elective hip replacement between January 1, 2016, and December 31, 2017, with continuous Medicare coverage for 3 months before and 6 months after surgery were included. Data were analyzed from February 2 to August 8, 2022.ExposuresTreatment at a hospital within a network that also owns at least 1 SNF based on the 2017 American Hospital Association survey.Main Outcomes and MeasuresRates of SNF utilization, 30-day readmissions, and price-standardized 30-day episode payments. Hierarchical multivariable logistic and linear regression clustered at hospitals was performed with adjusting for patient, hospital, and network characteristics.ResultsA total of 150 788 patients (61.4% women; mean [SD] age, 74.3 [6.4] years) underwent hip replacement. After risk adjustment, vertical SNF integration was associated with a higher rate of SNF utilization (21.7% [95% CI, 20.4%-23.0%] vs 19.7% [95% CI, 18.7%-20.7%]; adjusted odds ratio [aOR], 1.15 [95% CI, 1.03-1.29]; P = .01) and lower 30-day readmission rate (5.6% [95% CI, 5.4%-5.8%] vs 5.9% [95% CI, 5.7%-6.1%]; aOR, 0.94 [95% CI, 0.89-0.99]; P = .03). Despite higher SNF utilization, the total adjusted 30-day episode payments were slightly lower ($20 230 [95% CI, $20 035-$20 425] vs $20 487 [95% CI, $20 314-$20 660]; difference, −$275 [95% CI, −$15 to −$498]; P = .04) driven by lower postacute payments and shorter SNF length of stays. Adjusted readmission rates were particularly low for patients not sent to an SNF (3.6% [95% CI, 3.4%-3.7%]; P &lt; .001) but were significantly higher for patients with an SNF length of stay less than 5 days (41.3% [95% CI, 39.2%-43.3%]; P &lt; .001).Conclusions and RelevanceIn this cross-sectional study of Medicare beneficiaries undergoing elective hip replacements, vertical integration of SNFs in a hospital network was associated with higher rates of SNF utilization and lower rates of readmissions without evidence of higher overall episode payments. These findings support the purported value of integrating SNFs into hospital networks but also suggest that there is room for improving the postoperative care of patients in SNFs early in their stay.

show abstract

Trends in hospital-SNF relationships in the care of Medicare beneficiaries

Cited by 8 publications

References 18 publications

Hospitals Using Bundled Payment Report Reducing Skilled Nursing Facility Use And Improving Care Integration

Hospitals Using Bundled Payment Report Reducing Skilled Nursing Facility Use And Improving Care Integration

Prevalence of the Effects of Anxiety and Depression on People with Type 2 Diabetes Mellitus: An Analysis of Health Policy Studies in Improving the Quality of Life of Poor Families in the Urban Areas of West Lombok, Indonesia

Association of Skilled Nursing Facility Ownership by Health Care Networks With Utilization and Spending

Contact Info

Product

Resources

About