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 The QIS Expert

Safely Reducing Readmissions

 

Q. Based on QIS data, can you provide any current information on readmissions to hospitals from skilled nursing facilities (SNFs)?

 
A. In my June 2011 column, I described how QIS measures readmissions to hospitals from SNFs in 30 days and discussed why this has become so important for SNFs to measure. Since that time, interest in this topic has grown among hospitals because payment penalties from the Hospital Readmission Reduction Program (HRRP, as established by the Affordable Care Act) will begin in October 2012 for hospitals with higher-than-expected readmission rates for pneumonia, heart failure, and acute myocardial infarction.
 
This has resulted in pressure on SNFs to partner with hospitals to reduce readmission rates.
 
Other policy and private-sector initiatives are aimed at reducing hospital readmissions from SNFs. In its March 2012 report, the Medicare Payment Advisory Commission recommended that Congress direct the Department of Health and Human Services to reduce payments to SNFs with relatively high risk-adjusted rates of rehospitalization during Medicare-covered stays and be expanded to include a time period after discharge from the facility.
 
Importantly, the American Health Care Association (AHCA) has made reduction of readmissions to hospitals in 30 days one of four goals in its 2012 Quality Initiative.
 
Despite all of this activity, current and rigorous data are not widely available on SNF readmission rates to hospitals. A recent study based on 2011 Centers for Medicare & Medicaid Services (CMS) Hospital Compare data suggested that there has been no significant reduction in readmissions to hospitals for all hospital discharges with the three conditions included in the HRRP.
 
But reported data on the subset of patients discharged from hospitals to SNFs is no more recent than 2010, before there was much emphasis on readmissions from SNFs and before the fiscal year 2012 rule on it was adopted.
 
Data systems based on QIS do not depend on claims data and are much more current. At the 2012 AHCA Quality Symposium and during a March 2012 national webcast, for example, I presented an average readmission rate from SNFs in 2011 of 17.4 percent for a sample of close to 700 SNFs with 25 or more admissions, based on privately collected QIS data.
 
Similar analyses of 2012 QIS data suggest two findings: 1. Patient acuity is increasing over time in SNFs, resulting in higher risk of readmissions and the need for rigorous risk adjustment if rates are going to be compared over time; and 2. Risk-adjusted rates of readmission are decreasing in SNFs that are using QIS tools to measure and address root causes of readmission.
 
The take-home messages from this work are threefold. First, we must obtain real-time data on readmissions, such as QIS data, if we are going to measure and improve performance in this rapidly changing area. Data from 2010 and before, which is the case for most claims data, are of little relevance to current SNF care.
 
Second, we must risk adjust for the increasing acuity of SNF discharges from hospitals in order to determine if we are impacting readmission rates.
 
Third, using QIS methods can assist providers with managing readmissions to hospitals from SNFs, helping them to meet requirements of evolving public policy for SNFs and to partner with hospitals.
 
Andy Kramer, MD, is a long term care researcher and professor of medicine who was instrumental in the design and development of the Quality Indicator Survey (QIS).
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