WASHINGTON — The Medicare Payment Advisory Commission recently debated whether to recommend that payments for the hospital and postacute care be bundled together.
The issue arose out of concerns about frequent rehospitalizations and readmissions to skilled nursing facilities (SNF).
Analysis of data from 2004 to 2006 showed that 63% of skilled nursing facility residents were admitted to a hospital then discharged back to an SNF; 31% had two or more SNF-hospital-SNF cycles, MedPAC staff member Carol Carter said at a recent meeting of the commission.
A previous report by the Health and Human Services Department's Office of Inspector General found that patients who had three or more such cycles had a lower quality of care, said Ms. Carter.
The MedPAC analysis also found that patients who had repeat hospitalizations and readmissions to SNFs were more likely to be dual-eligible for Medicare and Medicaid and to be sicker than other patients. Of the readmissions, 51% were dual-eligible, compared with 33% of those who did not have repeat visits. Patients who had four or more hospital-SNF stay cycles during the 2-year period were also more likely to be classified as clinically complex than were nonrepeat patients, said Ms. Carter.
Some 74% of repeat patients were hospitalized for what were classified as “potentially avoidable” conditions, such as heart failure, respiratory infections, and urinary tract infections, she said.
Repeat hospital-SNF visits were much higher for patients in freestanding SNFs and in for-profit SNFs, Ms. Carter said.
She added it was probably not possible to eliminate all hospital readmissions. But she suggested aligning payment incentives between SNFs and hospitals, saying each entity could, under the current system, be rewarded for admissions to their facilities. She said SNFs can often convert patients from lower-paying Medicaid to higherpaying Medicare after a long hospital stay.
Ms. Carter proposed the Centers for Medicare and Medicaid Services start publicly reporting rehospitalization and readmission rates and consider using potentially avoidable rehospitalizations as a pay-for-performance measure.
Finally, she recommended bundling payments for the hospital and SNF, following the same path MedPAC has suggested for hospitals to hold inpatient and outpatient providers accountable for readmissions.
MedPAC meets again this month and in December, in preparation for its March report to Congress. It did not say when it would again take up the issue of rehospitalized SNF patients.