AHCA Weighs in on Hospital Readmissions

Starting in 2012, hospitals will incur financial penalties for certain 30-day readmissions. As these admissions are not totally in their control, outside partners in care, such as nursing homes and others, play a role. The American Health Care Association (AHCA) has weighed in on the issue.

One in five patients that are discharged from the hospital return within 30 days, costing Medicare $17.4 billion in 2010. Almost one-fourth of these beneficiaries are skilled nursing facility (SNF) patients, receiving post-acute care (recuperative or rehabilitative services). According to AHCA, SNFs want to help reduce this noting that skilled nursing care centers are already making strides to reduce rehospitalizations by using tools specifically targeted toward the issue, hiring additional staff, and improving the flow of information with hospitals and physicians.

But according to the group, more needs to be done. AHCA wants to incentivize the entire sector to achieve $2 billion in Medicare savings by 2021, and at the same time, better serve patients.

They have proposed a plan as follows:

1. After establishing a baseline for the SNF 30-day readmission rate and calculating costs associated with those readmissions, the Secretary of Health and Human Services would then set a targeted readmissions reduction goal for SNFs necessary to achieve $2 billion in savings from 2014-2021.
2. Skilled nursing facilities will then work to reduce hospital readmissions by at least the targeted amount.
3. If the savings target is not achieved, then SNF market basket updates (cost of living adjustments) will be reduced to make up for the shortfall in expected Medicare savings.
4. If SNFs meet the $2 billion in required savings, then SNFs would share any additional savings through lowered readmissions.

Of course, this is very much how hospitals will start to operate under bundled payments, ACOs and value based purchasing so it is only natural that the nursing home industry follow. The irony is that nursing homes for years have tried to de-institutionalize their image as hospital-like to home-like. But now as they move more into rehabilitation services, they indeed are moving away from home back to hospital.

Nothing wrong with that mind you. Just an observation.

Part of this is also to make up for lost revenue as the industry is still reeling from an 11 percent Medicare payment reduction that went into effect last Oct. 1. Skilled nursing facilities fought unsuccessfully to have the payment change phased in gradually rather than immediately.

Avoiding unnecessary hospital care is a good thing. And if the industry can improve their quality and be rewarded for it they should do so. After all, measuring and rewarding quality and patient experience is the future from skilled facilities to home care.

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@AHCA