Healthcare News & Insights

Does higher use of post-acute care lead to higher readmission rates?

ThinkstockPhotos-79077095Could how often a hospital uses post-acute care affect its readmission rates? According to a new study the answer is yes, and it’s not for the better. 

For years now spending on post-acute care (skilled nursing homes, inpatient rehab centers and home health care) has varied widely across the U.S. Some areas overuse it and others underuse it. But it still accounts for $62 billion annually in Medicare spending.

The study by UCLA researchers, which was published in the February issue of Medical Care, found some hospitals refer fewer than 3% of their inpatient surgery patients to inpatient facilities, while others send up to 40% of them.

Why such a huge difference?

According to a report by the Institute of Medicine, differences in the cost of post-acute care was the key driver of regional variation in Medicare spending.

The report found that if there were no variations in post-acute care spending, “total Medicare spending variation would drop by 73%” and “if there was no variation in both acute care and post-acute care spending, total Medicare spending variation would drop by 89%.”

The UCLA researchers also found some hospitals prescribed home health care for only 3% their patients, while others referred up to 58% of their patients. This finding caused the researchers to look into whether these vast differences correlated with differences in overall quality of care.

They looked at data for 112,620 patients treated at 217 hospitals in 39 states. The data came from the national surgery registry, Medicare claims and the American Hospital Association’s annual survey from 2005 through 2008. They figured out the relationship between post-acute care usage rates and hospital quality measure – mortality rates, complications, readmissions and lengths of stay.

Indirect measure of hospital quality

What they found: There wasn’t an association between how often hospitals used post-acute care and the number of recorded postoperative deaths or complications.

But there was a link between “indirect” measure of hospital quality, like length of stay and readmission rates, and the use of post-acute care. For example, hospitals that seemed to have a preference of sending their patients to inpatient facilities had shorter lengths of stay but higher readmission rates.

And hospitals with higher referral rates to inpatient facilities were more likely to readmit patients within 30 days (24.1%) vs. those who had lower referral rates (21.2%).

The study, however, didn’t find a similar link between referrals to home health care and hospital readmissions.

Other findings:

  • Teaching hospitals referred patients to home health care 21.4% of the time vs. 18% for non-teaching facilities, and
  • Hospitals with the shortest average length of stay used inpatient facilities more frequently (24% vs. 19.5%).

“These findings suggest that some hospitals may be using post-acute care as a substitute for inpatient care,” said Dr. Greg Sacks, the study’s lead investigator, a resident in general surgery at UCLA and a Robert Wood Johnson/Veterans Affairs Clinical Scholar, in a release from UCLA. “This might lead to patients being discharged from the hospital prematurely, which then results in higher readmission rates.”

Guidelines, further research needed

Currently, there are no guidelines to help facilities and their surgeons figure the best post-acute care services for their patients. That, coupled with the insurance industry’s push to reduce length of stays, may be causing hospitals to discharge patients before they’re ready, thus affecting their post-acute care decisions.

So what does this all mean?

According to the study, it suggests a strong need to further study the appropriate use of post-acute care to develop guidelines to assist in post-operative discharge planning.

Until then, there are a few things that should help. Most notably, the Medicare Post-Acute Care Transformation (IMPACT) Act which creates a standardized patient assessment tool that objectively compares quality and outcomes across post-acute care settings.

And the Centers for Medicare & Medicaid Services’ latest initiative to update discharge planning guidelines, which would revise the discharge planning requirements that hospitals, long-term-care facilities, inpatient rehab facilities, critical access hospitals, and home health agencies must meet in order to participate in the Medicare and Medicaid programs.

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