Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities

Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are a...

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Bibliographic Details
Published in:Health Affairs 2017-09, Vol.36 (9), p.1591-1598
Main Authors: McHugh, John P., Foster, Andrew, Mor, Vincent, Shield, Renée R., Trivedi, Amal N., Wetle, Terrie, Zinn, Jacqueline S., Tyler, Denise A.
Format: Article
Language:English
Subjects:
Accountable care organizations
Administrators
Beneficiaries
Censuses
Computer networks
Data analysis
Discharge
Effectiveness
Government programs
Health care
Health care management
Health care policy
Home health care
Hospitals
Interviews
Markets
Medicaid
Medicare
Networks
Nurses
Nursing
Patient control
Patients
Penalties
PPOs
Primary care
Prospective payment systems
Qualitative analysis
Qualitative research
Rates
Readmission
Reduction
Site visits
Social security
Subacute care
Trends
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Summary:Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009-13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March-October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2017.0211