In the last few years, rates of hospital readmissions have become a key indicator of care quality, and for good reason. When significant numbers of patients in post-acute care settings experience a decline in health – especially those with chronic and complex conditions like COPD or CHF – and need to be readmitted to the hospital, it puts a significant social and physical strain on patients and the health system alike.
By some estimates, our healthcare system spends $52.4 billion annually caring for patients who were readmitted to a hospital within 30 days. In 2018, there were 3.8 million adult hospital readmissions, which comes out to a 14 percent readmission rate and an average readmission cost of $15,200 per patient. It’s projected that more hospitals will face readmission penalties from the Centers for Medicare and Medicaid Services in 2024 compared to 2023.
Many of these readmissions are preventable, and can be attributed to suboptimal care quality and care coordination in post-acute settings. Maybe the patient develops an infection around a surgical site, or doesn’t adhere to their medication regimen, or the post-acute care staff misinterprets care instructions.
But whatever the reason, readmissions have a two-fold impact. They not only drive up the cost of care, but they create a glut of surplus patients in hospitals waiting to be discharged to a limited number of beds at a partner skilled nursing facility.
Discharge backlog causes
Wait time varies between organizations but according to a Massachusetts Health and Hospital Association report, as many as half the patients in the state were forced to wait over 30 days in the hospital before they could be transferred to a facility. The American Hospital Association reported that average length of stay increased over 19% for all patients in just three years. While often inevitable and out of providers’ control, these backlogs can cause a variety of suboptimal health outcomes for the patients affected by it as well as both hospitals and their staff.
Solving these post-acute care bottlenecks is easier said than done. Many patients discharged to skilled nursing facilities (SNF) have the most complex care needs and are most at-risk. If they are laying in bed most of the day they may be vulnerable to another illness. They may not receive appropriate rehab or therapy, and may develop a UTI, electrolyte imbalance, ulcer or pneumonia. SNF staff often don’t have enough practitioners onsite to closely monitor patients’ progress.
A recent KFF study noted that less than 20 percent of examined nursing facilities were able to meet the required number of hours for nurses in a center, suggesting that the majority of facilities across the country are severely understaffed. In an effort to optimize the available staff, facilities were forced to downsize the number of patients that they could admit, with 21% of facilities across the nation reducing the number of available beds.
Adding to the challenge, SNFs may have single social worker to follow patients’ progress post-discharge.
Issues caused by backlogs
While these care delays are already a nuisance to the patients on discharge lists, they also provide a great risk to their health as hospital stays become longer than anticipated. Studies completed by the World Health Organization have found that on an average, 1 out of every 100 patients in a hospital will be diagnosed with at least one health care-associated infection (HAI), which are illnesses that patients who are receiving care for another condition become infected with. The same study notes that on average, 1 out of every 10 patients affected by HAI will die. The longer a patient’s stay becomes, the more likely they are to contract one of these infections which could then cause even further complications.
Alleviating discharge backlogs
Hospital backlogs are a serious problem that impacts health systems, staff, patients, and even patients’ families who get frustrated at the time their loved ones spend awaiting necessary care. Here are measures hospitals and SNFs can take to mitigate hospital readmissions and address the ongoing backlogs:
- Implement robust care coordination: it is highly recommended that hospitals invest in additional staff and other resources to better monitor and gain further visibility into patients’ risk factors once they are discharged to a SNF. Hospitals should have more in-depth insights into patients’ health status during their SNF stay and for as long as 90 days post-SNF discharge. This will enable care coordination teams to provide timely care interventions to keep patients healthy and prevent them from being re-hospitalized. SNFs should consider investing in on-site physiatry resources to help facilitate more effective therapies and manage patients’ pain.
- Enhance discharge planning: the University of St. Augustine for Health Sciences recommends best practices to improve discharge planning, including starting discharge planning earlier and making the process more standardized, communicating pertinent medical information in a timely way, and enhanced follow up on patients’ health status with skilled nursing facilities or home care settings. More effective discharge planning can also help identify patients in hospitals who may not be ready to be discharged for medical or mental health reasons.
- Increasing family and patient engagement: Family caregivers play an incredibly vital role in ensuring patients’ transitions of care are seamless from one setting to another. The reason so many hospital readmissions are preventable is because they are often attributed to simple areas of confusion or miscommunication, such as a patient’s nutritional needs, or how to best manage pain, or medication requirements. When a patient is discharged home, giving family caregivers easy-to-understand care instructions can make a substantial difference in that patient’s health outcomes.
Hospitals and SNFs understand well the necessity to cut down on patient readmissions. It’s not just because of readmission penalties: they want to do the right thing by their patients and improve patient to staff ratios.
By making the right investments in improving care coordination, discharge planning and patient and family engagement, these facilities could see a substantial impact on care quality and a healthier bottom line.
Photo: elenabs, Getty Images
Dr. Afzal is a visionary in healthcare innovation, dedicating more than a decade to advancing value-based care models. As the co-founder and CEO of Puzzle Healthcare, he leads a nationally recognized company that specializes in post-acute care coordination and reducing hospital readmissions. Under his leadership, Puzzle Healthcare has garnered praise from several of the nation’s top healthcare systems and ACOs for its exceptional patient outcomes, improved care delivery, and effective reduction in readmission rates.
