Hospitals that are affiliated with accountable care organizations were able to reduce readmissions from skilled nursing facilities more quickly than other types of hospitals, according to a new study published in Health Affairs.
The research focused on the Shared Savings Program and the Pioneer ACO model, both noncommercial ACOs funded by Medicare. It also took into account a broad range of diagnoses -- 7,952 of them, in fact.
There was a general reduction in readmissions from 2007 to 2013, suggesting that all hospitals made efforts to reduce them, perhaps in anticipation of readmission penalties that were set to take effect around that time due to the Affordable Care Act. But the rate of reduction at ACO-affiliated hospitals was faster, implying that they discharged to skilled nursing facilities more effectively or did a better job at targeting at-risk patients. Enhanced information sharing and communication between hospitals and skilled nursing facilities may also have played a role.
Generally, the Pioneer ACO hospitals reduced 30-day readmissions by 3.1 percent, the Shared Savings Program hospitals by 4 percent and non-ACO facilities by 2.9 percent over the study period. Yet when readmissions from skilled nursing facilities were examined specifically, the reductions were greater: 17.7 percent for Shared Savings hospitals, 14.9 percent for Pioneer hospitals, and 13.1 percent for non-ACO set.
The relative reduction in readmissions from skilled nursing facilities within the first three days was even greater among ACO hospitals. Both Shared Savings and Pioneer hospitals saw 19.1 percent reductions, compared to 14.3 percent in non-ACO hospitals.
The more general reduction in rehospitalizations from skilled nursing facilities implies that all hospitals have made changes in discharge processes, or that most nursing facilities have focused more on treating patients in the facility as opposed to sending them to the hospital, the authors wrote. The Medicare Hospital Readmissions Reduction Program was credited as the largest driver of this trend, because even though the program didn't start until 2013, hospitals likely made some overhauls beforehand, since the Centers for Medicare and Medicaid Services uses three full years of previous data to determine hospital performance.
Hospitals discharge about 20 percent of their patients to skilled nursing facilities, the report said. In 2006, that rate was higher: The average 30-day readmission rate for fee-for-service Medicare patients who had previously been discharged to nursing facilities was 25 percent. That could in part be due to the inadequate integration of care, with the elderly in need of multiple healthcare services are, or were, highly fragmented and disjointed.
The authors advocate for skilled nursing facilities to have a more formal role in ACOs. To date, they're only included in a small portion of ACOs, with most ACOs contracting with skilled nursing facilities by including them in their preferred networks. That means they receive admissions from hospitals, but don't have any influence on ACO governance.
Including preferred skilled nursing facilities as partners in ACOs with joint investments in quality could, in the long run, lead to better health outcomes, the study said.