The availability of post-acute resources, including hospice and palliative care, has a significant impact on hospital readmissions, but greater coordination among providers could drive improvement.
The U.S. Centers for Medicare & Medicaid Services (CMS) penalizes hospitals for readmissions rates that exceed certain thresholds, but the agency does not account for the supply of post-acute providers available to patients in a providers’ service region.
Thus, conditions in the community likely impact readmission rates and hospitals could benefit from work to improve local access to post-acute care, the authors of a study published today in Health Affairs concluded.
This can include hospice and palliative care, both of which have been found to reduce readmissions, according to lead author Kenneth Griffith, assistant professor of health policy at Vanderbilt University.
“While if you live in an area that doesn’t have these options available, you might be more likely to be discharged either at home or to another nursing facility,” Griffith told Hospice News. “Then you increase your likelihood of being bounced back to the hospital as your health declines.”
Reducing hospitalizations, readmissions, and emergency department visits has emerged as a priority throughout the health care continuum as means to temper the nation’s rising health care spend. Increasingly, hospices and palliative care providers are leveraging their track records on those metrics as they build relationships with referral sources and payers.
Bringing down acute care utilization is also a key quality indicator for providers participating in alternative payment models or demonstrations, including ACO programs and the hospice component of the value-based insurance design model (VBID).
For the Health Affairs study, researchers examined 30-day readmission rates for Medicare patients who had been hospitalized between 2013 and 2019 for acute myocardial infarction, heart failure, or pneumonia.
The study sample included data from 3,042 unique hospitals, using the CMS Hospital Compare website, other government sources, and the American Hospital Association. (CMS has since rolled all of its former quality rating sites into its Care Compare online database.)
For patients with certain conditions, the availability of palliative care and the supply of skilled nursing beds contributed to lower readmissions. Patients who had easy access to primary care providers were also less likely to return to the hospital.
The study took into account hospital- or health system-based palliative care programs rather than those operated by hospices or stand-alone agencies.
“A hospital-based palliative care service may reduce readmissions through both improved patient-provider goal setting and increased referrals to hospice care,” the study indicated.
Researchers included a recommendation that CMS take community characteristics into account when evaluating hospital performance.
When hospital referral sources experience higher readmission rates, it could present an opportunity for hospice providers or other post-acute agencies to better coordinate care or form a partnership, according to Griffith.
“If your hospital is getting hit with penalties for high readmissions, perhaps you should take this more active role and develop and invest in post-discharge care options that might allow you to lower readmissions, so it’ll pay off benefits in the long term,” Griffith told Hospice News.
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