Doctors question nursing home fines for rehospitalization

Doctors worry patients may be kept at skilled nursing facilities longer than is necessary out of a fear of fines if a person has an adverse health event leading to rehospitalization.

By Stephen Feller

BLOOMINGTON, Ind., March 31 (UPI) -- The federal government is moving to make skilled nursing facilities more responsible for patient outcomes by fining them, in addition to the hospitals, when patients are rehospitalized within 30 days of release.

The new accountability requirements go into effect in 2018, and doctors are raising concerns about how to improve care practices to avoid both patient rehospitalization and the fines themselves, according to a commentary published in the Journal of American Geriatrics Society.


About one-fifth of older adults discharged from the hospital are sent to SNFs, rather than straight home, because they require additional care or rehabilitation. Use of the 15,000 SNFs in the United States has increased as insurance companies, and the government, look to bring down the overall costs of healthcare.

SNFs are designed for short-term care at a much lower cost than a hospital. A study by the U.S. Department of Health and Human Services found one-third of SNFs did not meet discharge requirements.

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While doctors recognize the new fines are designed to add accountability, and that the government is advocating for patients by requiring better care, they say there are several steps that could ensure better care. The authors also suggest there is a lack of evidence to show the fine's potential for success.


"Transition from the hospital to home is complicated -- and for those who go to a SNF, we are adding a another set of doctors and nurses with new instructions," said senior author Dr. Alexia Torke, IU Center for Aging Research and Regenstrief Institute investigator. "Good communication between the SNF clinicians, the patient's community doctors and the patient and caregiver are key."

Experts identify three major concerns: Communication between hospitals, SNFs, caregivers and patients is lacking and can contribute to better or worse healthcare; the potential for SNFs to keep a patient longer than medically necessary because of assistance that will prevent their going back to the hospital; and a lack of research to support assumptions the law will work.

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At least in part, the doctors said the potential of a fine could lead to longer, unnecessary stays at SNFs, whose mission is for shorter stays as bridge between the more expensive hospital and higher potential for injury or other complication at home.

"It's critical for the SNF staff to provide guidance to any patient going home so they understand things like changes in medications from those taken before hospitalization or prescribed upon hospital discharge, as well as needs for further therapy," Torke said. "To ensure continuity of care, they should also help or at least encourage the patient or caregiver to set up a follow-up appointment with the patient's primary care provider."


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