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Medicare to Implement Financial Penalties For Nursing Homes with High Hospital Readmission Rates

Finally a potentially good bit of news for nursing home residents. Modeled after a program that encourages low readmission rates to hospitals, the Centers for Medicare and Medicaid Services (CMS) will introduce a new financial incentive program in October 2018 for skilled nursing facilities. Once the rule is put into place, CMS will withhold 2% of a facility’s Medicare reimbursement until they have shown that they can keep down the number of their residents who return to a hospital within 30 days of discharge. The CMS proposed readmission rate is 20%, and according to reports, the 2015 national average was between 5-10%.

Chicago Hospitals Partnering with Selected Facilities to Reduce Readmission
Hospitals themselves have been under the gun since the Affordable Care Act introduced the Hospital Readmissions Reduction Program in late 2012. Hospitals with high readmission rates within 30 days of discharge are punished by receiving reduced Medicare and Medicaid payments. With readmission now a major quality measure for hospitals, many have chosen to invest in a patient’s care after they’ve left. A Crain’s Chicago Business article uses the Rush University hospital network as a prime example of how hospitals are pushing for better post-discharge care. The hospital system says that they have begun to cultivate a small referral list of skilled nursing facilities in an attempt to ensure their patients are being set up for long term success.  The hospital network has also begun encouraging their physicians and nursing staff to educate and inform clinical staff at the receiving facility about their transferred patients. Previously, the norm was to send medical records without a conversation actually taking place. Rush has also created partnerships that allow their own nurses to work at certain referral facilities. 

A New Rule, but Not a New Idea
The idea of keeping nursing home residents from repeatedly visiting hospitals is not a new one. For years, CMS has cited study after study that show most instances of nursing home resident hospital readmittance can be prevented, that the cost to Medicare for repeated hospitalizations is high, and that the emotional and physical difficulties that can accompany multiple hospital visits are not in a patient’s best interests. Improving the quality of care and safety at nursing homes and skilled nursing facilities has always been priority number one for CMS and with a 2015 report calling out that 1 in 4 nursing home residents will be readmitted to a hospital within 30 days of being discharged, the agency has decided to finally put a rule into effect.

Cutting down on preventable readmissions should always have been a priority for nursing homes, but given that the majority are for-profit, spending money to hire more staff and educate them on preventing hospital readmissions has not been on their to-do list. Now that CMS will officially withhold a percentage of reimbursement, maybe nursing homes will begin devoting more time, money, and human resources to ensure their residents stay out of the hospital. 

How to Find A Nursing Home’s Hospital Readmission Rates
The nursing home abuse and neglect attorneys of Levin & Perconti encourage you to do your research when it comes to the hospital readmission rates for a loved one’s nursing home. The Centers for Medicare and Medicaid Services maintain a rating system of nursing homes, including their hospital readmission rates. The site, Nursing Home Compare, tracks the state average, the national average, and each individual facility’s average for short stay residents (defined as those who spend 101 days or less at a skilled nursing facility). The lower the hospital readmission rate of your (or your loved one’s) facility, the better.

To find a nursing home’s hospital readmission rate, go to Nursing Home Compare and enter the information to find the facility in question. There are 5 rating tabs for each facility: General information, Health & fire safety inspections, Staffing, Quality of resident care, and penalties. Under the Quality of resident care tab, scroll down to where it says ‘short stay residents.’  Unfortunately the site does not currently collect information regarding hospital admission and readmission for long stay residents (those who spend over 101 days days in a skilled nursing facility).