scholarly journals Does Reducing Length of Stay Increase Rehospitalization of Medicare Fee-for-Service Beneficiaries Discharged to Skilled Nursing Facilities?

2013 ◽  
Vol 61 (9) ◽  
pp. 1443-1448 ◽  
Author(s):  
Mark A. Unruh ◽  
Amal N. Trivedi ◽  
David C. Grabowski ◽  
Vincent Mor
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facilities ◽  
Fee For Service ◽  
Nursing Facilities ◽  
Skilled Nursing

scholarly journals 2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization

2018 ◽  
Vol 2 (S1) ◽  
pp. 87-87
Author(s):  
Himali Weerahandi ◽  
Li Li ◽  
Jeph Herrin ◽  
Kumar Dharmarajan ◽  
Lucy Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Hazard Rate ◽  
Skilled Nursing Facilities ◽  
Unplanned Readmission ◽  
Time Interval ◽  
Fee For Service ◽  
Nursing Facilities ◽  
Heart Failure Hospitalization ◽  
Skilled Nursing

OBJECTIVES/SPECIFIC AIMS: Determine timing of risk of readmissions within 30 days among patients first discharged to a skilled nursing facilities (SNF) after heart failure hospitalization and subsequently discharged home. METHODS/STUDY POPULATION: This was a retrospective cohort study of patients with SNF stays of 30 days or less following discharge from a heart failure hospitalization. Patients were followed for 30 days following discharge from SNF. We categorized patients based on SNF length of stay (LOS): 1–6 days, 7–13 days, 14–30 days. We then fit a piecewise exponential Bayesian model with the outcome as time to readmission after discharge from SNF for each group. Our event of interest was unplanned readmission; death and planned readmissions were considered as competing risks. Our model examined 2 different time intervals following discharge from SNF: 0–3 days post SNF discharge and 4–30 days post SNF discharge. We reported the hazard rate (credible interval) of readmission for each time interval. We examined all Medicare fee-for-service (FFS) patients 65 and older admitted from July 2012 to June 2015 with a principal discharge diagnosis of HF, based on methods adopted by the Centers for Medicare and Medicaid Services (CMS) for hospital quality measurement. RESULTS/ANTICIPATED RESULTS: Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home [median age, 84 years (IQR; 78–89); female, 61.0%]; 13,257 (19.2%) were discharged with home care, 54,328 (80.4%) without. Median length of SNF admission was 17 days (IQR; 11–22). In total, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge; median time to readmission was 9 days (IQR; 3–18). The hazard rate of readmission for each group was significantly increased on days 0–3 after discharge from SNF compared with days 4–30 after discharge from SNF. In addition, the hazard rate of readmission during the first 0–3 days after discharge from SNF decreased as the LOS in SNF increased. DISCUSSION/SIGNIFICANCE OF IMPACT: The hazard rate of readmission after SNF discharge following heart failure hospitalization is highest during the first 6 days home. Length of stay at SNF also has an effect on risk of readmission immediately after discharge from SNF; patients with a longer length of stay in SNF were less likely to be readmitted in the first 3 days after discharge from SNF.

Ownership Status and Length of Stay in Skilled Nursing Facilities

2015 ◽  
Vol 35 (3) ◽  
pp. 303-320 ◽  
Author(s):  
John R. Bowblis ◽  
John Horowitz ◽  
Christopher S. Brunt
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Ownership Status

scholarly journals MANAGING MANAGED CARE: PERSPECTIVES FROM KEY STAKEHOLDERS IN SKILLED NURSING FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S498-S499
Author(s):  
Andrea E Daddato ◽  
Cynthia Drake ◽  
Edward A Miller ◽  
Pamela Nadash ◽  
Denise Tyler ◽  
...  
Keyword(s):  
Managed Care ◽  
Patient Care ◽  
Decision Makers ◽  
Skilled Nursing Facilities ◽  
Future Research ◽  
Fee For Service ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Key Stakeholders ◽  
The Relationship

Abstract In recent years, Medicare Advantage (MA) plan enrollment has increased, a trend that is expected to continue. Many skilled nursing facilities (SNFs) rely on MA managed care insurer referrals to maintain their census in a market with high competition for post-acute care patients. This study used semi-structured interviews to describe the relationship between MA plans and SNFs from the perspective of key decision-makers in SNFs. Twenty-three interviews were conducted with key stakeholders from 11 Denver Metropolitan area SNFs. A combined purposive-snowball sampling approach was used to identify and recruit select staff from the participating facilities. Interviews focused on the relationship between MA plans and SNFs, including mechanisms of control, power dynamics, and preferences for MA versus Fee-for-Service (FFS) Medicare patients. Key findings included: 1) challenges SNF staff had navigating MA plans’ case management processes, a key mechanism used by MA plans to influence the behavior of SNF decision-makers; 2) MA plans exercising power over beneficiaries’ length of stay, potentially leading to early discharge and heightened risk for rehospitalization; 3) SNF preference for admitting Medicare FFS over MA patients due to higher rates of Medicare FFS reimbursement and greater control over patient care. SNFs are increasingly reliant on MA plans for patient referrals and revenue. The themes suggest that this growing reliance may place SNFs at odds with MA plans on how best to manage overall patient care. It is therefore important that future research investigate how MA plans’ influence over care affects patient outcomes in SNFs and other post-acute settings.

Abstract WP351: Using Standard Work to Improve the Discharge Process on a Neurology Division

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Rose M Donnelly ◽  
Tim Tranor ◽  
Julie Griffin ◽  
Kalcee Foreman ◽  
Adrienne Ford ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multidisciplinary Team ◽  
Skilled Nursing Facilities ◽  
Multidisciplinary Teams ◽  
Discharge Process ◽  
Nursing Facilities ◽  
Mobile Computer ◽  
Skilled Nursing ◽  
Standard Work ◽  
Inadequate Information

Background and Issues: Patient volume increased significantly over first half of 2011 on the Neurology Service. Bed occupancy increased by 14% over previous year and bed availability became a major constraint. Data showed, patients were discharged late in the day or sometimes stayed an extra night because discharge orders were released too late to place patients in rehab or skilled nursing facilities. Only 16% of patients were discharged by 2:00 pm due to communication barriers and inadequate information exchanged between multidisciplinary teams. There was also an issue with inconsistent acceptance criteria from primary placement facilities which resulted in a longer length of stay. Purpose: Primary goal of project was to free up capacity on the Nursing Division to accommodate the increase in patient volumes without increasing staffing or the number of available beds. Methods: In September 2011, a multidisciplinary team was assembled to understand causes of the problems and develop solutions to resolve. Solutions implemented include working with partner Rehab and Skilled Nursing Facilities to define standardized Acceptance Guidelines to ensure issues could be addressed before day of discharge. Also, processes for releasing discharge orders were redesigned so orders were more frequently written and placed “on hold” the day before expected discharge. A mobile computer was issued to physician rounding teams so orders could be released during rounds instead of batch-released in the afternoon. Additionally, team communication was significantly improved by standardizing a daily multidisciplinary team huddle and implementing a visual communication board to track key information about patients to proactively plan for discharge. Results: The overall length of stay of patients on the Neurology Service decreased from 4.26 days in 2011 to 3.69 days in 2012. Conclusions: Many variables contributed to the decrease in length of stay for patients in this study. No decisive conclusions can be made about the effectiveness of any particular variable. Other variables during this timeframe likely contributed, however the authors of this study presented the most likely factors. Although the findings are exciting, further analysis is needed to isolate the main drivers.

scholarly journals Waiving The Three-Day Rule: Admissions And Length-Of-Stay At Hospitals And Skilled Nursing Facilities Did Not Increase

2015 ◽  
Vol 34 (8) ◽  
pp. 1324-1330 ◽  
Author(s):  
Regina C. Grebla ◽  
Laura Keohane ◽  
Yoojin Lee ◽  
Lewis A. Lipsitz ◽  
Momotazur Rahman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing

scholarly journals The congressional mandate: standardised post-acute care quality measures

2019 ◽  
Vol 26 (8) ◽  
pp. 1-10
Author(s):  
Christine Kroll ◽  
Thomas Fisher
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Functional Outcomes ◽  
Care Quality ◽  
Skilled Nursing Facilities ◽  
Rehabilitation Services ◽  
Nursing Facilities ◽  
Data Set ◽  
Skilled Nursing ◽  
Post Acute Care

Background/Aims This study describes the relationships between rehabilitation services intensity, post-acute care measures of Functional Performance Change, and length of stay for episodes of care provided in 93 skilled nursing facilities in the US. Methods The study used a secondary analysis of existing data on Medicare beneficiaries admitted to skilled nursing facilities from acute hospitals (n=518) who subsequently returned to the community. Data were selected from Minimum Data Set Section GG items reported by therapists. Results Statistically significant correlations were identified between rehabilitation services intensity and functional outcomes (P<0.001); and between rehabilitation intensity, medical condition, and length of stay (P<0.001) for rehabilitation patients in skilled nursing facilities. Conclusions The intensity of occupational and physical rehabilitation therapy services correlate with patients achieving higher functional outcomes, specifically improvement in self-care and mobility.

scholarly journals The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs

2019 ◽  
Vol 54 (6) ◽  
pp. 1184-1192 ◽  
Author(s):  
Rachel M. Werner ◽  
R. Tamara Konetzka ◽  
Mingyu Qi ◽  
Norma B. Coe
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Impact

Length of stay in skilled nursing facilities is longer for patients with dementia

2003 ◽  
Vol 5 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Marwan N. Sabbagh ◽  
Nina Silverberg ◽  
Bashar Majeed ◽  
Shefali Samant ◽  
D. Larry Sparks ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing
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