Some healthy competition may be good for nursing home providers.
At least that’s what Kevin Griffith, assistant professor in the Department of Health Policy at Vanderbilt University Medical Center and an investigator at the Partnered Evidence-based Policy Resource Center, found when looking at hospital discharge patterns.
In a study published in Health Affairs this month, Griffith found that from 2013 to 2019 postdischarge care options varied widely across the country but that 30-day readmission rates were lower at hospitals that operated a palliative care service or had a greater local supply of primary care physicians and licensed nursing home beds.
“There certainly is variation in quality between SNFs. At least having a healthy market and access to these things for patients seems to be beneficial for readmissions,” he told Skilled Nursing News. “If you are the only game in town, patients don’t really have a choice and perhaps you don’t have the same incentives to improve the quality of care.”
As hospitals continue to look for ways to reduce readmissions, Griffith thinks the study provides insight as to why local SNF beds may be more desirable than increased home health options.
“In some areas of the country there isn’t a lot of options for post-acute care and we’re hoping our research shows that we need to start accounting for the fact that hospitals in some areas simply have more resources than others and that’s going to affect patient outcomes,” Griffith said .
In general, he found that increased local postdischarge care supply is shown to correspond with a reduction in hospital readmissions.
Griffith also found that a greater availability of home health agencies was associated with higher readmission rates.
He would like to see more studies done to assess the impact home health agencies have on readmission rates, however, one theory is that the higher readmissions rates may be due to frequent staffing changes and associated discontinuities in care.
“With home health, there’s not the same level of scrutiny and data collection on their outcomes as there might be for hospitals or even SNFs,” Griffith added.
The study looked at data on hospital 30-day readmission rates obtained from the Centers for Medicare & Medicaid Services’ Hospital Compare website from 2013 to 2019. The final sample included 3,042 unique hospitals with a median of fewer than 200 beds and an average daily census of fewer than 100 patients.
The mean hospital’s catchment area contained more than 620 SNF beds, 24 primary care physicians, 48 nurse practitioners, 18 licensed nursing home beds and three home health agencies per 100,000 residents.
Griffith would also like to see hospitals take a “more active role” in tracking where their patients are going and what their outcomes are.
He said that hospitals generally take a “passive role” with regards to where their patients choose to go after they leave and he thinks they should do a better job of communicating what options are available to them.
“You should be encouraging patients to go to the one that is providing better quality of care,” he added.
Griffith thinks the study could have implications for CMS’s hospital readmissions reduction program (HRRP). The program’s risk-adjustment algorithm currently does not account for postdischarge care supply and inclusion of such a measure could lead to lower admission targets for hospitals in areas with a greater number of SNFs or nursing home beds, according to the study.
Still, Griffith thinks the data should give skilled nursing providers some relief that their role in the post-acute care continuum is secure.
“I think it’s a good news story for SNFs and I think you could take this that having access to more beds is a good thing,” Griffith said.
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