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Reducing Hospital Readmission Rates

Many local residents end up in nursing homes after a hospital stay. Each Chicago nursing home lawyer at our firm knows that the impetus to help a loved one enter a skilled nursing facility is often a major health crisis that reveals that the senior is not longer able to live safely at home. Frequently, a family is forced to frantically work to find the right facility before their loved one is discharged from the hospital so that the senior has a place to go right away that will provide the necessary care.

Considering the fact that many residents go directly from hospital to nursing homes, “hospital readmission rates” have become an important indicators of the quality of care provided at certain long-term care facilities. This refers to the number of residents who experience medical problems that require hospitalization in a set period of time after being discharged from the hospital to the nursing home.

Of course, our Illinois nursing home neglect lawyers appreciate that certain factors have to be considered when analyzing these rates. For one thing, the comparison only works if the health level of residents at these facilities is generally the same across facilities. If one facility somehow took all residents with more severe medical conditions then it wouldn’t be fair to point fingers at the facility for high readmission rates-the readmission level would be somewhat expected. Yet, skewed admissions are not common, and, if they do exist, they can usually be controlled.

Therefore, it is no surprise that new programs are popping up seeking to tie nursing home reimbursements to hospital readmission rates. As described in a story last week at McKnight’s Long-Term Care News, these efforts are growing in popularity as part of overall changes in healthcare reform.

The story explains how these readmissions are quite costly-significantly contributing to the rise in overall healthcare costs. One health consultant explained how partnerships between hospitals and skilled nursing providers-including bundled payments-are likely to increase in the coming years. “Obamacare,” or the Affordable Care Act, mandated certain payment related punishments for high readmission rates. However, advocates say that this focus on hospital readmission rates will persist regardless of whether the U.S. Supreme Court upholds the constitutionality of the bill.

Nursing home lawyers will be intrigued to hear one consult suggest that “the train has already left the station…this will become the new normal. Private payers are very focused on coordinated care.”

While balancing budgets is obviously a universal goal, it is important to understand how this culture change will contribute or not contribute to rates of nursing home neglect and abuse. On one hand, it is obviously better if residents need less hospitalization following admittance to a nursing home. On the other hand, it is important that these facilities not sacrifice resident care in order to avoid increasing their readmission rate. We understand that sometimes facilities are unsure of whether to send a resident to the hospital for a potential problem. Failure to ensure that the senior receives timely medical care is often the different between life and death for some residents. Nursing homes must be held accountable if they are ever influenced in their treatment of residents because of profit concerns.

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