Care Context JANUARY 2010
Rehospitalizations From Skilled Nursing Facilities
A Multifaceted Issue That Calls for Innovative Policy Solutions
Introduction
THERE IS BROAD INTEREST in improving the quality and efficiency of the health care system in the United States. Policymakers are increasingly focused on the rate of rehospitalizations as an area for potential improvement.1,2 An estimated one-fifth of Medicare beneficiaries who are discharged from the hospital are readmitted within 30 days. Ninety percent of those admissions are unplanned, and they cost Medicare an estimated $17.4 billion in 2004.3,4 In addition to their cost, rehospitalizations appear to increase the risk of health complications, resulting in greater functional and cognitive impairment for patients.5 Nursing facilities are the dominant provider of Medicare post-acute care services, and they represent an important element of any strategy to reduce rehospitalizations. A more detailed exploration of rehospitalizations from nursing facilities suggests the issue is complex and driven by the interplay of several factors. Rehospitalization rates vary substantially by region, implying that local practice norms may play an important role. Specific state and nursing facility characteristics – such as higher Medicaid payments and more generous nurse staffing – also have significant impacts on rehospitalization. Although some causes of rehospitalization are not well understood, the research done to date suggests that efforts to reduce reshopitalizations will have the greatest impact if they reach beyond the Medicare program and consider nursing facilities’ broader operating and reimbursement environment.