Hospitals referring patients to a preferred network of skilled nursing facilities reduced readmissions for those patients by a greater rate than hospitals that offered a wider list for patients to choose from, according to a new study.
Researchers identified four “case hospitals” with a preferred SNF network and 12 that did not use such a network, and compared Medicare readmissions data. Between 2009 and 2013, the rate of readmissions from SNFs in the network decreased by 6.1 percentage points, while it decreased by 1.6 percentage points for the other hospitals.
The overall readmission rates decreases were not different by a statistically significant margin, according to the study published in Health Affairs. Readmission rates decreased by 3.7 percentage points between 2009 and 2013 for the case hospitals and 2.1 percentage points for the others.
The researchers found that in the four case hospitals, patients were more likely to have coordinated care plans that shared the load between the hospital and SNF, which can be crucial as these patients are often among the sickest. In one case, a hospital nurse practitioner visited patients at the in-network SNFs each day. Those patients also received a weekly visit by a physician, in addition to care from the team at the nursing facility.
The researchers also conducted interviews with staff members at all 16 hospitals and several themes emerged as to how the case hospitals found success in their SNF networks:
- Hospitals with networks took advantage of existing provider relationships. These existing relationships also offered more leverage to improve performance, instead of relying solely on quality ratings.
- An understanding of cost drivers led hospitals to create a SNF network. Some of the case hospitals decided to implement a network because they saw they were spending a lot on nursing home care, and others were pushed by outside motivators, like accountable care organization participation.
- Data management is key. Gathering data from the SNFs in the network is necessary to maintaining quality and can make it more successful.
- Interpretations of “patient choice” vary. Many of the hospitals without networks had a very strict view of “patient choice,” and thought a preferred network was too limiting.