How Medicare Length of Stay in SNFs Could Relate to Rehospitalizations

Patient rehospitalizations from skilled nursing facilities is a costly problem the industry is working to fix, especially after a study revealed accelerated cognitive decline in elderly patients after a hospitalization, and a panel of experts at a recent session during NIC’s 2012 Skilled Nursing Investment Forum said readmissions could be linked to length of stay in a facility.

Across all levels of care, rehospitalizations cost the Medicare system $25 billion a year, said Mark Jaeckle, Manager of Clinical Services at GE Capital’s Healthcare Financial Services, adding that one in three Medicare patients who are admitted to skilled nursing facilities end up being readmitted to hospitals within 30 days.

Data trends show that patients are spending fewer days in hospitals, said Jaeckle. At the same time, he continued, admission to skilled nursing facilities from hospitals has gone up, and hospital readmission rates have also risen.

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Skilled nursing facility patients’ average length of stay could be a significant factor in whether or not they’re rehospitalized after transitioning to post-acute care, said Michael Jones, CEO and Principal of Healthtique Group, an owner/operator/manager of senior living communities.

The average length of stay for Medicare residents in a skilled nursing facility is 29 days. But in one of Jones’ facilities, patients were only staying for an average of 19 days—which he later determined to be when co-pays for Medicare Advantage plans kicked in.

Not only do shorter lengths of stay mean a facility is losing out on the revenue that can be generated by more Medicare days, but this can also put a resident at higher risk of hospital readmission if they’re not fully recovered, he said.

This whole dynamic gets much more important moving forward with accountable care organizations (ACOs) and other forms of managed care, said Jones. Shorter stays leading to higher readmissions could damage a facility’s reputation, both for prospective patients and for referral relationships.

Jones said he was told that many of the patients in that particular skilled nursing facility simply could not afford the copays, and that was “just the way it is.”

That’s not an acceptable answer, said Jones. “It’s incumbent upon us to make it better, to convince them to stay longer and get better.” There may not be a hard-and-fast method for increasing average length of stays, but it could help to have discussions with patients and their family members to tell the importance of longer stays, and work out a payment plan, he said.

Having effective communications, accuracy, and compliance is the recipe for success, Jaeckle said.

Rehospitalization rate management will be “critical” for future skilled nursing facility success, he continued, especially as “others—including hospital referral sources—will know your rates even if you don’t.”

Written by Alyssa Gerace

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