Updated: Jan 31
Readmissions from skilled nursing facilities impact everyone. There is the most immediate problem of the health of the resident. Readmissions expose residents to increased levels of stress, morbidity, and mortality. Then there is the disruption of the SNF environment, given the need for both ambulance and paramedics to respond. It is a distraction to staff and an alarming concern to residents and their families.
There is also the burden to the emergency departments of the local hospitals, which is only exacerbated by the likelihood of ED admissions after hours when SNF staff are less capable of handling acute unscheduled care and EDs are often at their peak. In 2020, according to the National Center for Biotechnology Information, SNFs accounted for 14 million visits to the ED annually, and as many as 20% could have been avoided. More alarmingly, of the frailest residents who were admitted to the ED, 78% may not have had to happen.
These readmissions place an undue burden on ED staff and drive up the cost of healthcare in general. It also hurts the SNFs through lower census and penalties from Medicare.
Many readmissions can be avoided if the SNF leadership staff has a clearer picture of how, when, and why readmission decisions are being made.
Understanding How Medicare Handles Readmissions
In 2012, as part of the Patient Protection and Affordable Care Act, Medicare enacted the Readmissions Reduction Program (HRRP). This program is aimed at, of course, reducing re-admits to EDs from SNFs. These readmissions are a huge driver of healthcare costs. Medicare sees HRRP as encouraging acute care hospitals and SNFs to maintain communication and care coordination so that residents receive the best care.
The HRRP program reduces payments to SNFs for readmissions within 30 days of the resident’s release from the acute care facility if the resident is readmitted for the same reason. If a resident is admitted to an acute care facility for a UTI, and then readmitted two weeks later for the same condition, then the HRRP applies. If they are readmitted the second time for a heart attack, the HRRP does not apply.
The reduction in payment is based on a rolling performance period and is capped at 3%. Given the tight margins for SNFs, a 3% reduction can make a difference in the balance sheet, especially if your SNF facility has an ongoing problem with readmissions.
In 2012, the first year of the HRRP, more than 2,000 healthcare facilities were fined more than $280 million for readmissions. By 2017, fines totaled $528 million, almost double.
An article in Modern Healthcare pointed out that when CMS starts measuring things and tying performance to improvement, one would expect things to get better. That has not happened here. One explanation is that SNFs can be penalized for readmissions even if the resident has left their facility and returned home, where the SNF doesn’t have control over the decision. This problem is exacerbated by pressure from providers to shorten the length of stay in the SNF.
By the way, the HRRP also provides incentives, too. SNF’s can receive a bonus of up to 1.6% in Medicare payments if they hit their HRRP numbers. It’s tough, though. In 2019, only 3% of SNF facilities say they saw the maximum bonus.
How Can CareWork Help with Readmissions?
There are things the SNF leadership can do to reduce HRRP fines and perhaps even get some of that bonus money. One of them is CareWork.
CareWork is an operational platform for SNFs and senior care communities that ties together the systems companies are already using to give administration and leaders a 360-degree view of clinical and company operations in one place. Resident, clinical, and staffing data comes together in a single view so that teams can spot trends, gain insight into readmissions that may have been avoidable, and take proactive steps to reduce the readmission rate. Some of the things you might derive from such reports include:
Which Residents are Readmitted Most Often?
This allows you to focus on these residents, educating frontline staff to their needs. A good example is a UTI. Standard treatment for a UTI includes making sure the resident maintains an increase in water intake. Staff needs to make sure that happens.
Determine if Residents are Being Readmitted at Higher Volumes During Certain Shifts
This could point to a couple of issues. One might be a need for additional staff training. Another is a more unified approach to decision making. Employees, as much as possible, should use the same criteria interpretations in determining whether a resident needs to return to the hospital.
Determine if Residents are being Readmitted More Often During Certain Days of the Week
Again, this points to potential problems with staff training, staff levels, or perhaps scheduling too many inexperienced staff at one time. Staff schedulers should focus on making sure that the combined staff has the proper experience levels to care for residents.
Residents with a Particular Diagnosis Readmitted More Often
This again points to training issues with staff. When residents return from a hospital stay, they are accompanied by aftercare instructions, including medication, exercise recommendations, diet restrictions, rehabilitative therapies, etc. It is imperative to make sure that all staff are aware of this.
Look at the Numbers
A lot of facilities don’t have any idea how much revenue they lose in terms of lost census days and Medicare penalties for avoidable readmissions. Merely bringing that to the attention of your leadership team can make a difference.
It’s About Data and Trends
It is a time-proven observation that recognizing there is a problem gets you halfway to solving it. In the case of CareWork, you are instantly provided with the data. The important thing is to look for trends in the information. Once you have identified a trend, then you can drill down deeper to the root cause.
Without the data, though, you are blind, and only guessing.
How Does CareWork Help?
We streamline operations and make it easy to keep an eye on the trends that lead to readmissions and a host of other management-related issues at SNFs and senior care facilities. By integrating the systems SNFs already use, we give teams a one-stop-shop to proactively manage tasks, view analytics, and manage workflow. We make care work easier.
Ready to work more efficiently? If so, contact us today.