ED Visits By Nursing Home Residents 'Disproportionately High'

Cheryl Clark, for HealthLeaders Media , October 30, 2013

In its March 2012 report, MedPAC commissioners wrote that they "recommend reducing payments to SNFs with relatively high rates of rehospitalizations. Avoidable rehospitalizations of SNF patients increase Medicare’s spending, expose beneficiaries to additional disruptive care transitions, and can result in hospital-acquired infections or other adverse health consequences.”

The report noted that "a rehospitalization policy for SNFs would create comparable policies for SNFs and hospitals, thereby encouraging providers in both settings to work together to better manage the transitions between them."

In a report released earlier this month in Health Services Research, Rahman and co-authors at Brown and Harvard University linked reduced 30-day hospital readmissions among nursing home patients cared for in facilities that have linkages with those hospitals.

"Hospitals that own an SNF send about 45% of their patients to a single SNF compared to 26% in case of hospitals without a SNF," Rahman and colleagues wrote.

The greater the concentration of discharges from a hospital to a single SNF, the lower the number of rehospitalizations, "particularly in the days following SNF transfer…[a] finding that applies both to hospitals that own a SNF and to those that do not."

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2 comments on "ED Visits By Nursing Home Residents 'Disproportionately High'"

M. Bennet Broner, PhD (10/30/2013 at 12:14 PM)
Years ago, I performed quality assessments of nursing home care for Medicaid and I was surprised at the frequency with which residents were transported to the ED though their conditions could likely have been treated "in-house". Transportation, often by ambulance, occurred for not only suspected UTIs, but also for a minimal spike in temperature, and even for ear wax removal. These facilities had medical directors and many of the patients had personal physicians listed on their charts. Could these professionals not have been consulted first or could they have visited the patient at the home rather than their being transported to overburdened EDs?

Deb Collier (10/30/2013 at 10:08 AM)
SNF medical care is fragmented and limited by the episodic medical oversight provided by the team of medical providers which may change daily. They are not staffed to deliver preventative care through continuous monitoring of chronic conditions. Even when we bring issues to their attention, they are passive and when challenged, call an ambulance. Basic proactive measures are not standard such as a urine dip after treatment for a UTI or removal of a catheter. Is that because CMS does not pay or authorize? It takes over 24 hours to implement any medication or treatment change and then the subsequent aides and nurses do not always follow orders (daily weight - pressure stockings - hydration)because they are short staffed and pressured to care for numerous "guests" simultaneously. Two hospitalizations in three weeks is costly in many terms but of most importance to us, it delays rehab and reduces the chances of any level of recovery. Keep researching this topic. We can do better for our parents and loved ones.




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