Hospital Staffs Don’t Always Know Why SNFs Make the ‘Preferred’ Cut

The staff members tasked with guiding residents from hospitals to post-acute care options frequently feel restricted during the process — and often don’t even know why certain SNFs are classified as preferred partners.

Anti-steering rules, or regulations that prevent hospitals from recommending specific skilled nursing facilities, can sometimes serve as a general gag for discharge staff, a new report on care transitions from the United Hospital Fund determined.

“The regulations are there to protect patient choice and avoid steerage of patients for the financial benefits of the hospitals, but I think that there’s a varied understanding in terms of what hospital staff is actually permitted and not permitted to do,” Joan Guzik, director of quality improvement at the New York City-based non-profit and co-author of the report, told SNN. “I think perhaps some more organizational attention to that particular issue might be helpful.”


In addition, while skilled nursing operators are frequently exhorted to keep lengths of stay and hospitalizations low, that doesn’t mean that the people in charge of sending residents to their buildings can use that information as a selling point.

“Interestingly, most discharge planning teams were unaware about what data or information their hospital/health system used to determine what facilities would participate in their PAC network,” the authors noted.

Administrators and frontline staff at eight New York hospitals told Guzik and co-author Pooja Kothari that patients specifically ask staff for advice about which post-acute option to pick — though their specific reaction to those questions varied.


“A few teams were more comfortable providing informal recommendations while others felt a lot more constrained and would only provide patients with a list of SNFs to choose from,” Guzik and Kothari wrote. “Some also did not want to provide recommendations because their perspective on SNFs and priorities may differ from the patient’s.”

The health care professionals that contributed to the report, which also included representatives from five Empire State nursing homes, collectively held a dim view of the Centers for Medicare & Medicaid Services’ Nursing Home Compare tool. Though the federal government pitches the website, which provides information about individual facilities’ five-star quality ratings, as a consumer-facing resource, staffers said discharge planners are the typical end user of the service.

“There is poor health literacy and education, so even if you did talk about, the best option is to really go and tour for these family members because, even though we suggest it, I don’t really see them using that as the tool to make a decision,” one worker told the UHF researchers.

Hospital patients also struggle with understanding exactly what a stay in a skilled nursing facility entails, Kothari — a project manager at the UHF — said.

“What does it mean to go to a skilled nursing facility? What services are offered? This kinds of things are really important,” Kothari told SNN.

Despite growing calls for SNFs to begin taking higher-acuity patients in anticipation of the Patient-Driven Payment Model this fall, hospital staff expressed frustration when trying to place residents with more complicated medical needs. This cohort of patients include those with multiple comorbidities, dementia, substance abuse issues, and residents who would require special services such as dialysis or ventilator care.

“In one instance, they described having to send out a patient’s application to all the SNFs in an entire New York City borough,” they wrote.

The report, released Wednesday, marks the latest entry in the UHF’s exploration of care transitions as part of its “Difficult Decisions” series, which also explored the potential clinical and financial effects of poor discharge planning in a separate report released last month.

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