A recent study in “The Journal of Post Acute and Long-Term Care Medicine” shows that skilled nursing facilities are increasingly at the center of attention when it comes to patient outcomes. Beginning next year, Medicare will penalize SNFs (as well as hospitals) that have re-hospitalizations within 30 days of discharge. Obviously, SNFs need to figure out their formula for improved patient outcomes pretty quickly.
How do SNFs improve patient outcomes? Well, the study, “Transitions from Skilled Nursing Facility to Home: The Relationship of Early Outpatient Care to Hospital Readmission,” found that a home health visit was the best way to reduce the likelihood of a readmission. The conclusion being that for patients discharged from a SNF to home, “a home health visit within a week of discharge is associated with reduced hazard of 30-day hospital readmissions.”
We wanted to see where SNFs fit in terms of being on target or in trouble with their home health referrals. So, we took a look at SNF referrals to Home Health agencies as a percentage of total discharges. From the lowest (U.S. Virgin Islands at 0% and Alaska at 9%) to the highest (Connecticut and Massachusetts at 52% and 54% respectively, here’s what we found:
Additionally, we found that there was no correlation between average length of stay and home health usage. Therefore, using home health services does not result in shorter average lengths of stay and thereby dismissing the notion that SNFs’ revenue is somehow negatively impacted by their referring to home health agencies. Note: Our statistics are based on the claim from the next site of care after SNF discharge, not the discharge code on the SNF claim, which we have historically found to be less accurate.
The Bottom Line
Certainly for SNFs in states where home health agency referrals are below average, there is quite a bit of room for improved patient outcomes via home health visits. For SNFs where home health agency referrals are above average, other metrics can be used to identify if there is room to improve. Clearly, there is opportunity for SNF’s to reach Massachusetts and Connecticut referral levels. In fact, Massachusetts has been a bastion of Accountable Care Organization (ACO’s), which could account for their higher levels.
Where does your state stand? And what about your local market? Please contact us to discuss the specifics of your territory.