SNF Hospital Admission Rates Higher Amid Staffing Challenges, GAO Report Says

Out of thousands of skilled nursing facilities (SNFs) across the country, Medicare spent nearly $28 billion in 2019 on short-term care for 1.5 million beneficiaries, but in a study released this week, The U.S. Government Accountability Office argues that SNF hospital readmission rates are higher than they should be due to staffing challenges.

It noted that stronger payment incentives to provide better care would help.

GAO analyzed CMS staffing and critical incidents data, information on Care Compare and Medicare claims data for 2018 and 2019 and interviewed Centers for Medicare and Medicaid Services (CMS) officials and other stakeholders for the study.

Medicare spent an estimated $5 billion in 2018 on critical incidents that the CMS defines as potentially preventable, the GAO study showed, with 377,000 hospital readmissions occurring within 30 days of the SNF admission. 

Without stronger payment incentives, Medicare is unlikely to reduce the billions spent on potentially preventable critical incidents or the patient harm that can occur from them, the GAO argued.

The office recommends the Department of Health and Human Services implement appropriate payment reductions for SNFs that spend Medicare dollars on potentially preventable critical incidents — hospital readmissions and ER visits that occur within 30 days of the SNF admissions.

SNF value-based purchasing programs were suggested as possible solutions to better incentivize SNFs and avoid preventable critical incidents.

The up to 2% in reductions of certain SNF payments that CMS implements to incentivize operators to improve care does not address additional reductions, according to the GAO.

“Experts have noted that payment incentives under the current law may not be sufficient to motivate SNFs to improve their staffing, which in turn could lead to reductions in critical incidents,” researchers in the study argued. 

While nearly all of the SNFs, 99%, were shown to meet the federal requirement for a registered nurse on-site with eight hours per day, less than a quarter met staffing thresholds for minimum registered nurse and total nurse staffing that CMS has identified as needed to avoid quality problems, the study showed. 

Average RN staffing hours was also shown to decrease about 40% on weekends, limiting the ability of beneficiaries to make informed choices among SNFs when choosing a facility.