Hospitals Provide Too Little Guidance in SNF Selection

Getting on a preferred provider list with a hospital as a skilled nursing partner is no easy feat, as it can require proving high-quality clinical outcomes.

However, information about provider quality often never makes it to a patient who is discharged from a hospital, according to a recent study. This leaves the patient with a list of preferred providers, but no way to tell which facility they should pick. 

Researchers in an August Health Affairs study, “Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals,” noted “little is known about how patients select a post-acute facility.” The study reviewed 138 interviews with hospital staff members of 16 hospitals and 25 SNFs as well as 98 patients in 14 of the SNFs.


Hospitals, which have been incentivized to form stronger partnerships with SNFs and other post acute care providers since the implementation of the Affordable Care Act (ACA), play a role in where patients go for post-acute care, but more often than not are not providing patients with any information about care facilities other than the name and location.

In some cases, patients were given a list of up to 100 facilities in the surrounding area, according to Denise Tyler, senior research health policy analyst in the Aging Disability and Long Term Care program at RTI International in Waltham, Mass.

“In the vast majority of cases, people are given a printed list of SNFs in their city,” Tyler told Skilled Nursing News. “As many as 100 facilities were listed, and all that was on [the list] was the name, the address and a phone number.”


Only one hospital out of the 16 interviewed had a color coded list with preferred providers that were vetted for quality by the hospital, according to Tyler. 

For patients, that means selecting a facility can be “hectic,” and they “often rely on word of mouth” or even just a facility’s location or appearance to make a decision on where to receive skilled care, according to the study.

“They described the process as stressful, and they didn’t know where to turn for information,” Tyler said. “They’d end up choosing the nearest place to their home from the list, or, if a friend or family member had been at a facility, they went to that one. For a third of people interviewed, this was not their first time at a SNF. They returned to the same one [they had visited before], even in cases where people had bad experiences.”

Basing decisions on arbitrary information—such as location, rather than quality—could potentially impact clinical outcomes, as well, Tyler said.

As most SNF admissions come directly from hospitals discharging patients to post-acute care, the lack of direction to patients was surprising to researchers, Tyler said. Not to mention, hospitals have a financial stake in ensuring patients are cared for after a discharge and can be penalized by the Centers for Medicare & Medicaid Services (CMS) for high readmission rates. 

“The biggest surprise was that hospitals aren’t doing more in steering patients, given they are penalized for readmissions,” Tyler said. “You’d think they’d want to do everything they could, and that’s not the case.”

Part of the problem with the lack of information shuttled to patients in the midst of a discharge process may be confusion with Social Security laws that guarantee patients free choice of providers. While patients can receive care from any institution, agency or person qualified, hospitals may not realize they can assist in selecting better-quality facilities or provide more information to allow patients to do so, the study says. Most hospitals went with an “extreme interpretation” of this statute when providing consumer choice, and didn’t even refer patients to CMS’ compare website to look up information on quality. 

“The statute simply says people should not be restricted in their providers,” Tyler said. “A hospital that gives a list of facilities but points out which ones are vetted and of superior quality is still a choice, but a more informed choice.”

To improve the process and possibly patient outcomes, CMS could clarify the statute to give hospitals a better idea of what information they can provide without restricting consumer choice, Tyler suggested. As SNFs push to become preferred providers with hospitals, conversations at the executive level between providers could also potentially improve this process, she added.

Written by Amy Baxter

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