Blog by Mel Green, Director of Business Development and Public Relations, GrandView Pharmacy

There was a recent study conducted by Avalere that shows Medicare beneficiaries are spending less days in skilled nursing facilities (SNFs) since 2009 on a per capita basis. Avalere’s analysis discovered that there is a change in how hospitals are handling Medicare beneficiaries. There is a growing trend of hospitals utilizing frequent observation stays rather than admitting them for an inpatient hospital care.

A significant amount of our elder population (persons 65 or older) are often discharged to post-acute care facilities once surgery or initial treatments are completed at hospitals. The patients discharge from the hospital to a post-acute care facility to complete rehabilitation, recover (with monitored care) or simply complete the management process of their illness. The United States current Medicare program covers up to 100 days in a skilled nursing facility for eligible care. To qualify for a treatment in a SNF a patient must have had at least a three days inpatient care at a hospital prior to being admitted to the SNF. So, this new trend of hospitals utilizing observation stays rather than admitting Medicare beneficiaries is significantly reducing the number of patients eligible for a covered stay at SNF following their hospital release.

Avalere’s analysis of beneficiaries in traditional fee-for-service (FFS) Medicare, SNF utilization discovered that there was a decline every year since 2009. In years prior to 2016 there were 1,808 SNF days per 1,000 Medicare fee-for-service (FFS) beneficiaries compared to only 1,539 in 2016. Many healthcare professionals speculate that this 15% decline is a direct response to the huge financial penalties that hospitals incurred due to the Hospital Readmissions Reduction Program that was put in place nearly six years ago by the Centers of Medicare Services (CMS).

There are several other elements that could have impacted the decline in Medicare beneficiary admissions to SNFs. However, Avalere analysis did not observe shifts in the proportion of discharges to SNFs relative to home health care, and other types of post-acute care settings.

As the incredible financial burden of hospital readmissions has been realized it abundantly clear that the finical strain has negatively affected the relationship between hospitals and SNFs. So, how are SNFs going to be able reduce or stop this growing trend? SNFs will need to become more innovative, and they will need to constantly sell themselves to the hospitals in their markets. There will be even more pressure on the SNFs to sell their value as a reliable post-acute care facility that provides care that produces positive patient outcomes and has little- to-zero risk of a patient’s readmission to the hospital.

SNFs will need to rely on and hold their vendor partners to high standards of services and ensure that they are an integral part of their care team. A readmission resulting in poor rehab treatment from their therapy provider or a trip back to the hospital relating to mismanaged medications could be a “death sentence” for a SNF trying to capture Medicare beneficiary admissions from area hospitals.

At GrandView we have begun working on programs and investing in technologies that could reduce the risk of readmissions related to poor management of medications. Our IMPACT was developed to reduce readmissions by managing the delivery of accurate and timely medications throughout every transition point of a person’s care. Our innovative program is designed to have medications delivered to the patient at the time of discharge so that they are leaving the hospital with correct medications and they will have no delays in getting medications once they arrive at the SNF. Once the patient is completed with their stay at the SNF we also offer the same delivery and management program as they transition home. Our IMPACT program allows for medication monitoring and ensures that there is no delay in any medication therapies, which leads to a reduction in hospital readmissions. To learn more about our IMPACT program and our other solutions that can help reduce hospital readmissions click here.


About the Author

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