Hospital readmission rates appeared to be impacted by the post-discharge care options available in their communities in a July Health Affairs study, calling into question calculations the federal government uses to determine care quality and, subsequently, reimbursement.
Specifically, researchers found lower 30-day readmission rates following acute myocardial infarction, heart failure or pneumonia discharge among hospitals with more primary care physicians or licensed nursing home beds in their local area between 2013 and 2019.
Other post-discharge care supply was associated with declines in readmissions for certain diseases only. Palliative care availability, for instance, was tied to fewer readmissions following acute myocardial infarction while a greater supply of skilled nursing facility (SNF) beds was linked to fewer acute myocardial infarction and heart failure readmissions.
“Our results suggest that hospitals may take a more active role in the development of post-discharge care options in their communities or partner with existing infrastructure to improve continuity of care and clinical outcomes and to avoid penalties under the [Hospitals Readmissions Reduction Program (HRRP)],” the researcher wrote in Health Affairs.
On the other hand, local home health agencies were tied to an increase in heart failure readmissions while greater local supply of nurse practitioners was associated with a significant increase in readmissions for the three conditions.
Based on these findings, the researchers proposed adjusting the Centers for Medicare & Medicaid Services (CMS’) HRRP algorithm so that hospitals in areas with more primary care, SNFs or licensed nursing home beds have lower readmission targets, while those with more home health agencies have higher targets. These post-discharge supply-based targets could also vary by condition when appropriate, they wrote.
As for the nurses, the researchers warned policymakers not to jump to conclusions based on their findings alone. Nurses have been at the core of several programs that successfully reduced readmission rates, they wrote, and it’s possible that a higher supply of nurses in a particular county could be tied to the acuity of their patients or a shortage of other medical resources.
The researchers built their analysis using annual data the CMS, the American Hospital Association and the Health Resources and Services Administration collected between 2013 and 2019. Post-discharge care measures were measured on a per capita basis within a hospital’s catchment area with models controlling for institutional, demographic and CMS payment incentive factors.
Insufficient post-discharge care supply has become a growing area of concern for the country. Particularly during the winter’s omicron surge, reduced workforce and capacity among these settings caused logjams among hospitals unable to discharge patients to continuing care.
Organizations representing these facilities are also warning the Biden administration that proposed CMS payment cuts for 2023 will further threaten the post-discharge and long-term care landscape.