More on Reimbursement

Shorter stays in a skilled nursing facility tied to higher risk for readmission

Avoiding readmissions is one the top goals for providers who seek to avoid financial penalties linked to high rates.

Jeff Lagasse, Associate Editor

High hospital readmission rates indicate that many elderly heart failure patients may be sent home too soon from skilled nursing facilities, suggests a new study in the Journal of Post-Acute and Long-Term Care Medicine.

Led by researchers from NYU School of Medicine, the study shows that the risk of hospital readmission among heart failure patients discharged home after staying at a skilled nursing facility is high -- almost 25 percent within 30 days of discharge.

The findings showed gaps in discharge planning from skilled nursing facilities, and that the transition home requires more thorough preparation and training.


Avoiding readmissions is one the top goals for providers who seek to avoid financial penalties from the Centers for Medicare and Medicaid Services.

Researchers say referrals to SNFs after hospitalization are common and aim to ease the transition from the hospital to home and prevent readmission by increasing patients' physical strength and ability to take care of themselves.

For the study, researchers analyzed Medicare data from 2012 to 2015 that included about 67,585 heart failure patients ages 65 and older and examined who was readmitted to the hospital within 30 days of discharge from a SNF.

Among the study's key findings was that the risk of hospital readmission was as much as four times higher for patients discharged from a SNF with stays of two days or less, compared to those who stayed longer. This early readmission risk dropped by half for those patients who stayed at a SNF between one and two weeks.


The authors suspect that longer stays gave patients more rehabilitation time and more time to recover from their heart failure hospitalization by practicing a new exercise regimen, diet or management of medications.

They caution that their study did not evaluate the severity of the patients' heart failure, a factor that could impact the length of stay in a SNF. However, their findings reveal a pattern of increased risk for those with shorter stays.

To lower rates of hospital readmission, the study suggests identifying patients with complex health needs and creating more individualized care plans in advance of hospital discharge to the SNF.


In August 2018, CMS finalized rules for increasing payment to skilled nursing facilities, inpatient rehab and psychiatric facilities and included a new patient-driven payment model which ties reimbursement to patient conditions and care.

CMS said the final rule puts patients over paperwork, ease provider burden, and make significant strides in modernizing Medicare.

Twitter: @JELagasse

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