Study: Bundled payments drive hospitals to reduce referrals to SNFs, improve coordination

Hospitals are rethinking how often they discharge patients to SNFs as a result of bundled payment participating, according to a new study. (Getty/KatarzynaBialasiewicz)

Bundled payments are pushing hospitals to cut back on discharges to skilled nursing facilities, according to a new study.

Researchers at the University of Pennsylvania interviewed staff and leaders at 22 hospitals across the country to gain a better picture of how hospitals are responding to the payment incentives built into bundles for joint replacement. They found that a “cultural shift” in how providers plan for discharge after these surgeries, leading more patients to be sent home.

Jane Zhu, M.D., national clinician scholar at Penn’s Perelman School of Medicine and the study’s lead author, told FierceHealthcare that more hospitals saw that high skilled nursing utilization was inflating costs.

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Sending more joint replacement patients home for care made sense as a key strategy, she said, since most are not especially ill and are undergoing an elective procedure. “Hospitals seem to really be responding to these payment incentives from bundled payments, and are driven by cost first and foremost,” Zhu said.

RELATED: Analysis—Mandatory bundled payments have few advantages over voluntary bundles

The researchers also found that bundled payments were pushing hospitals to better coordinate with skilled nursing facilities and other post-acute care providers in a number of ways. For some systems, this meant purchasing or opening its own SNF, while others took steps to better share electronic health record data or create a preferred post-acute care network.

Other hospitals were embedding their own hospitalists in skilled nursing facilities to improve communication and coordination, according to the study.

Data sharing and analytics is a crucial piece to this. All of the hospitals in the study said they were collecting and monitoring data on SNFs, which improved communication.

“A lot of them focused on care coordination,” Zhu said, “and really streamlining the communication between the acute provider and post-acute provider.”

RELATED: Industry Voices—How skilled nursing facilities could cut costs without cutting care

Zhu said that hard data hasn’t quite caught up to current innovations in delivery and payment reform, so the interviews were a first step in painting a more complete image of how hospitals on the front lines are responding to these incentives.

Future research, she said, should dig further into whether hospitals more widely are responding to payment reforms with similar strategies. Plus, further study can illuminate the impact discharge planning changes are having on the SNFs themselves.

“In this kind of payment climate, a lot of these impacts are yet to be seen, but they’re likely to be enormous for SNFs and post-acute care sector,” Zhu said.

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