A team approach to reducing unnecessary hospitalizations

Skilled nursing facilities often get criticized for their less-than-stellar performance when it comes to resident hospitalizations. Hospitalization is a common occurrence; in 2006, 23.5 percent of persons admitted to a post-acute SNF were rehospitalized within 30 days, according to a 2010 report that appeared in Health Affairs.

An article in the September 29 issue of The New England Journal of Medicine recounts this statistic and others that, on first glance, place much of the blame for these high numbers on the skilled nursing industry—suggesting that many of these hospitalizations are “inappropriate, avoidable or related to conditions that could be treated outside the hospital setting.” The authors also point to financial incentives to hospitalize residents stemming from a misalignment of Medicare and Medicaid programs that work at cross-purposes in terms of savings and expenses.

But halfway through the article, the authors (two medical doctors), come to skilled nursing’s defense. They note that in light of the fiscal challenges and the shortage of healthcare professionals trained in long-term care, not all nursing homes are able to safely evaluate and manage changes in the condition of the clinically complex nursing home population. “Setting unrealistic expectations and providing incentives to poorly prepared nursing homes to manage such care rather than transferring residents to a hospital could have unintended negative effects on the quality of care and health outcomes,” state the authors.

The authors then go on to suggest that quality-assurance and performance-improvement programs required by the Affordable Care Act (ACA) “will help focus nursing homes on efforts to reduce preventable transfers.” They recommend that savings to Medicare from prevented hospitalizations should be used to support nursing home infrastructure—in particular, to pay for more trained registered nurses and nurse practitioners, since higher RN staffing levels and NP-physician teams are associated with lower hospitalization rates.”

And finally, the authors propose a multi-faceted approach to preventing hospitalization of residents with a “commitment of energy and resources; teamwork among healthcare funders, regulators, healthcare professionals, nursing homes and hospitals;” and—amen to this—a true focus on resident-centered care.”

Patricia Sheehan

Patricia Sheehan was Editor in Chief of I Advance Senior Care / Long Term Living from 2010-2013. She is now manager, communications at Nestlé USA.