scholarly journals RACIAL DISPARITIES IN 30-DAY READMISSION RATES AMONG MEDICARE PATIENTS DISCHARGED TO SKILLED NURSING FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S780-S780
Author(s):  
Maricruz Rivera-Hernandez ◽  
Maricruz Rivera-Hernandez ◽  
Momotazur Rahman ◽  
Vincent Mor ◽  
Amal N Trivedi
Keyword(s):  
Skilled Nursing Facility ◽  
Ethnic Disparities ◽  
Fee For Service ◽  
Nursing Facilities ◽  
Readmission Rates ◽  
Value Based Purchasing ◽  
Nursing Facility ◽  
Data Set ◽  
Skilled Nursing ◽  
American Health Care

Abstract The 30-Day All-Cause Readmission Measure is part of the Skilled Nursing Facility Value-Based Purchasing (SNFVBP) beginning 2019. The objective of the study was to characterize racial and ethnic disparities in 30-day rehospitalization rates from SNF among fee-for-service (FFS) and Medicare Advantage (MA) patients using the Minimum Data Set. The American Health Care Association risk-adjusted model was used. The primary independent variables were race/ethnicity and enrollment in FFS and MA. The sample included 1,813,963 patients from 15,412 SNFs across the US in 2015. Readmission rates were lower for whites. However, MA patients had readmission rates that were ~1 to 2 percentage points lower. In addition, we also found that African-Americans had higher readmission rates than whites, even when they received care within the same SNF. The inclusion of MA patients could change SNF penalties. Successful efforts to reduce rehospitalizations in SNF settings often require improving care coordination and care planning.

scholarly journals Correlates of Skilled Nursing Facility (SNF) Performance in the SNF Value-Based Purchasing Program

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 83-83
Author(s):  
Dan Andersen ◽  
Sherly Binu ◽  
Mike Sacca
Keyword(s):  
Quality Care ◽  
Skilled Nursing Facility ◽  
Prospective Payment System ◽  
Fiscal Year ◽  
Value Based Purchasing ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Actual Performance ◽  
For Profit ◽  
Matched Data

Abstract We examined the results of the 2020 skilled nursing facility (SNF) value-based purchasing (SNF VBP) program to identify correlates and potential drivers of SNF performance in this program. The SNF VBP program provides incentive payments to SNFs based on their performance on a risk-adjusted hospital readmission measure (i.e., the rate at which SNF residents are admitted back to the hospital within 30-days of being admitted to the SNF). SNFs are assessed on this measure for both improvement compared to their historical baseline and overall achievement compared to their peers. All SNFs that are covered under Medicare’s prospective payment system are included in the SNF VBP program. We performed analyses to assess the correlation between individual SNFs’ performance in the 2020 SNF VBP (n=15,201), which is based on actual performance in fiscal year 2018, with contemporaneous matched data related to SNF health inspection results, staffing, and performance on quality measures (these data form the basis of the five-star quality rating system on the Nursing Home Compare website). We also examined longitudinal trends in these non-SNF VBP program variables and their association with changes in SNF performance in the SNF VBP program. We controlled for important SNF-specific factors (e.g., for-profit status, connected to a hospital). We found strong contemporaneous and longitudinal associations between SNF VBP program performance and some, but not all, of these factors. Our findings are supported by decades of empirical research in SNF quality and highlight potential policy alternatives that could further incentivize high quality care in SNFs.

scholarly journals Racial Differences in Post-Acute Transition After Hip Fracture in Medicare Patients With ADRD

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 666-667
Author(s):  
Indrakshi Roy ◽  
Amol Karmarkar ◽  
Amit Kumar ◽  
Meghan Warren ◽  
Patricia Pohl ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Racial Differences ◽  
Home Health Care ◽  
Multinomial Logistic Regression ◽  
Skilled Nursing Facility ◽  
Ethnic Disparities ◽  
Inpatient Rehabilitation ◽  
Patient Characteristics ◽  
Nursing Facility ◽  
Skilled Nursing

Abstract The incidence of hip fractures in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. However, there are no standardized post-acute transition models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute transitions vary by race/ethnicity. Using 100% Medicare data (2016-2017) for 120,179 older adults with ADRD, we conduct multinomial logistic regression, to examine the association between race and post-acute discharge locations (proportion discharged to skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home with Home Health Care [HHC]), after accounting for patient characteristics. Compared to non-Hispanic Whites, Hispanics have a significantly lower odds ratio for discharge to HHC 0.62 (95%CI=0.53-0.73), IRF 0.44 (CI=0.39-0.51), and SNF 0.26 (CI=0.23-0.30). Improving care in patients with ADRD and reducing racial and ethnic disparities in quality of care and health outcomes will be discussed.

scholarly journals Clinical Courses and Characteristics of Residents During a SARS-CoV-2 Outbreak at a Central Indiana Skilled Nursing Facility

2020 ◽  
Vol 3 ◽  
Author(s):  
Lauren Albert ◽  
Kristi Lieb ◽  
Laramie Mack ◽  
Kathleen Unroe
Keyword(s):  
Older Adults ◽  
Case Reports ◽  
Skilled Nursing Facility ◽  
Nursing Facilities ◽  
Retrospective Case ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Increased Risk ◽  
Symptom Load ◽  
Retrospective Case Study

Background/Objective: Older adults such as skilled nursing facility residents have increased risk of serious SARS-CoV-2 infection and comprise a large proportion of the COVID-19 pandemic’s deceased—the US Centers for Medicare & Medicaid Services report 232,831 cases and 38,518 resident deaths to date. Recent case reports reveal, as in other diseases, older adults may experience atypical symptomology, complicating identification of ill residents and efforts to slow transmission. While a few facility outbreaks have been characterized epidemiologically, little research exists regarding clinical timelines and trajectories which residents experience during COVID-19 illness.   Methods: From May 9, 2020-June 1, 2020, daily notes on each COVID-19 positive resident’s status (n = 69) were taken by the medical director of a central Indiana nursing facility. Combined with a retrospective resident chart review of this same period, these notes were examined for COVID-19 infection symptoms and illness timelines to descriptively categorize a number of common illness trajectories and symptoms seen in residents with SARS-CoV-2 infection.  Results: Residents fit four descriptive clinical timelines: concurrent symptom load with quick death (Avg 5.6 days) (n = 5), accumulating symptom load with gradual decline (Avg. 13.9 days) (n = 9), prolonged active symptom load with periods of stabilization and symptom reoccurrence (n = 42), and asymptomatic or atypical symptom load (n = 12). Most common symptoms were fever, hypoxia, anorexia, and fatigue/malaise. Of the 14 residents who died (20.3% of infected), 8 died in the facility and 6 died in the hospital.  Conclusion and Implications: This retrospective case study adds to literature describing the presentation and symptomology of SARS-CoV-2 infection in residents of skilled nursing facilities and aids efforts to evaluate resident presentation, prognosis, and disease course. Robust descriptions of expected clinical courses may support realistic expectations of disease progression for residents and their family members experiencing future outbreaks.

scholarly journals Economic Burden of Osteoporosis-Related Fractures in the US Medicare Population

2020 ◽  
pp. 106002802097051 ◽  
Author(s):  
Setareh A. Williams ◽  
Shanette G. Daigle ◽  
Richard Weiss ◽  
Yamei Wang ◽  
Tarun Arora ◽  
...  
Keyword(s):  
Economic Burden ◽  
Linear Models ◽  
Hospice Care ◽  
Skilled Nursing Facility ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Public Health Burden ◽  
Osteoporosis Related Fracture

Background Osteoporosis-related fractures are an important public health burden. Objective To examine health care costs in Medicare patients with an osteoporosis-related fracture. Methods Medicare fee-for-service members with an osteoporosis-related fracture between January 1, 2010, to September 30, 2014 were included. A nonfracture comparator group was selected by propensity score matching. Generalized linear models using a gamma distribution were used to compare costs between fracture and nonfracture cohorts. Results A total of 885 676 Medicare beneficiaries had fracture(s) and met inclusion criteria. Average age was 80.5 (±8.4) years; 91% were White, and 94% female. Mean all-cause costs were greater in the fracture vs nonfracture cohort ($47 163.25 vs $16 034.61) overall and for men ($52 273.79 vs $17 352.68). The highest mean costs were for skilled nursing facility ($29 216), inpatient costs ($24 190.19), and hospice care ($20 996.83). The highest incremental costs versus the nonfracture cohort were for hip ($71 057.83 vs $16 807.74), spine ($37 543.87 vs $16 860.49), and radius/ulna ($24 505.27 vs $14 673.86). Total medical and pharmacy costs for patients who experienced a second fracture were higher compared with those who did not ($78 137.59 vs $44 467.47). Proportionally more patients in the fracture versus nonfracture cohort died (18% vs 9.3%), with higher death rates among men (20% vs 11%). Conclusion and Relevance The current findings suggest a significant economic burden associated with fractures. Early identification and treatment of patients at high risk for fractures is of paramount importance for secondary prevention and reduced mortality.

scholarly journals REDUCING AVOIDABLE FACILITY TRANSFERS: THE RAFT MODEL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S769-S770
Author(s):  
Daniel Stadler
Keyword(s):  
Medical Center ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Life Sustaining Treatment ◽  
Acute Care Facilities ◽  
Dartmouth Hitchcock Medical

Abstract Reducing Avoidable Facility Transfers (RAFT) is a Dartmouth-developed program that identifies and honors “what matters most” to patients residing in skilled nursing facilities in a value-based, sustainable way. RAFT aims to reduce avoidable facility transfers of older adults from long-term care and post-acute care facilities to emergency departments (ED). Key components of RAFT presently include (1) systematically eliciting goals of care for all skilled nursing facility residents, (2) translating these goals into orders using the Physician Orders for Life-Sustaining Treatment form, (3) documenting patient wishes about hospitalization, and (4) ensuring that these wishes inform decision-making during acute crises. Data from a pilot program, begun in 2016 with three rural skilled nursing facilities in collaboration with the Dartmouth-Hitchcock Medical Center geriatric practice, showed a 35% reduction in monthly ED transfers, a 30.5% reduction in monthly hospitalizations, and a 50.7% reduction in monthly ED and hospitalization-related charges.

The Association Between Skilled Nursing Facility Care Quality and 30-Day Readmission Rates After Hospitalization for Heart Failure

2014 ◽  
Vol 30 (3) ◽  
pp. 205-213 ◽  
Author(s):  
Owolabi Ogunneye ◽  
Michael B. Rothberg ◽  
Jennifer Friderici ◽  
Mara T. Slawsky ◽  
Vijay T. Gadiraju ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skilled Nursing Facility ◽  
Care Quality ◽  
Readmission Rates ◽  
Nursing Facility ◽  
Skilled Nursing

Hospitalization and hospital discharge destinations after chemotherapy: Using the Oncology Care Model (OCM) methodology in 2012–2015 Medicare data.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 113-113
Author(s):  
Yi Peng ◽  
Jiannong Liu ◽  
Leon Raskin ◽  
Michael Anthony Kelsh ◽  
Rebecca Zaha ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Financial Incentives ◽  
Quality Care ◽  
Skilled Nursing Facility ◽  
Cancer Type ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Practice Performance

113 Background: The Medicare OCM gives financial incentives for efficient, high-quality care. Hospitalizations of cancer patients receiving chemotherapy substantially increases costs. We assessed reasons for hospitalization and hospitalization discharge destinations after chemotherapy in cancer patients. Methods: We applied OCM methodology in a Medicare fee-for-service 20% sample data to estimate 6-month patient episodes triggered by chemotherapy from 2012 to 2015. We summarized the most frequent reasons for hospitalization (using ICD-9-CM codes in the first 5 positions of hospital claims) and the discharge destinations among all episodes and by cancer type. Results: Of 485,186 6-month episodes in 255,229 patients, 121,886 (25%) episodes had ≥1 hospitalization. The most frequent reasons for hospitalization were infection (13%), anemia (7%), dehydration (5%), and congestive heart failure (CHF; 3%; Table). Most hospitalized patients were discharged to home (71%) or a skilled nursing facility (SNF; 13%); some died in the hospital (6%) or went to hospice (5%). Reasons for hospitalization and discharge destination varied by cancer type. Patients with lung cancer had the highest rates of infection and anemia and higher proportions of death and hospice discharge compared with other cancers. Conclusions: Among Medicare beneficiaries receiving chemotherapy, hospitalizations most often occurred as a result of infection or anemia. Patients were most often discharged to home or SNF. Variations across cancer types in the reasons for hospitalization, as well as discharge destinations, should be considered when evaluating OCM practice performance. [Table: see text]

scholarly journals Racial Disparities in Health Service Utilization Among Medicare Fee-for-Service Beneficiaries Adjusting for Multiple Chronic Conditions

2017 ◽  
Vol 30 (8) ◽  
pp. 1224-1243 ◽  
Author(s):  
Krupa Gandhi ◽  
Eunjung Lim ◽  
James Davis ◽  
John J. Chen
Keyword(s):  
Racial Disparities ◽  
Chronic Conditions ◽  
Skilled Nursing Facility ◽  
Home Health ◽  
Pacific Islanders ◽  
Multiple Chronic Conditions ◽  
Fee For Service ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Racial Disparities In Health

Objective: To examine racial disparities in health services utilization in Hawaii among Medicare fee-for-service beneficiaries aged 65 years and above. Method: All-cause utilization of inpatient, outpatient, emergency, home health agency, and skilled nursing facility admissions were investigated using 2012 Medicare data. For each type of service, multivariable logistic regression model was used to investigate racial disparities adjusting for sociodemographic factors and multiple chronic conditions. Results: Of the 84,212 beneficiaries, 27.8% were White, 27.4% were Asian, 27.3% were Pacific Islanders; 70.3% had two or more chronic conditions and 10.5% had six or more. Compared with Whites, all racial groups experienced underutilization across all types of services. As the number of chronic conditions increased, the utilization of inpatient, home health care, and skilled nursing facility dramatically increased. Discussion: Disparities persist among Asians and Pacific Islanders who encounter the problem of underutilization of various health services compared with Whites.

Disease management partnership with skilled nursing facility improves heart failure 30-day readmission rates

Heart & Lung ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 556
Author(s):  
Tasha Beck Freitag ◽  
Sandra Young ◽  
Macall Perez ◽  
Dan Altland ◽  
Tamela Sterner
Keyword(s):  
Heart Failure ◽  
Disease Management ◽  
Skilled Nursing Facility ◽  
Readmission Rates ◽  
Nursing Facility ◽  
Skilled Nursing
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