Kaiser Report Explores High Hospital Use by Long-Term Care Residents
We are always looking for great information that helps us get ready for the inevitable change facing health care providers. Earlier this week, I received an email from one of our leading consultants, Nancy Rehkamp. My sense is that you will benefit as much as I have from the wise words and suggested reading she offers. Please let us know your thoughts on this matter.
Her email concerned a new report from the Kaiser Family Foundation titled, “To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care Facility Residents.” This topic also served as last week's cover story in Modern Healthcare (“Bad Trip”) and was part of a one day seminar examining the high medicare spending for benificiaries in long-term care. The briefing featured the director of CMS, Donald Berwick, as the keynote speaker.
The hospitalization report ties in with much of the work being done to reduce readmissions, ambulatory sensitive conditions, and costs—all of which continues to be phased into Medicare payment reform. The upshot is that the foundation and CMS concluded:
- Skilled nursing facilities and assisted living have limited capacity to deal with medical issues
- Physician preference is to send resident to the hospital
- Liability concerns are significant
- Providers feel that financial incentives for treatment are at the hospital
- Admits are higher the first few months due to lack of relationships between the resident, their family, the attending doctor, and the facility
- Lack of advance care planning
- Unspoken preference to have care at the hospital
- Behavioral health issues
- Reluctance of family to challenge hospitalization
By extension there was discussion at the conference about each of these variables being causes of readmissions from other post-acute sites of services, such as home care. The strategies to address these were ones that have been discussed for a while and some of which will be demos in the future. One that was highlighted was that hospice in SNF was providing too little for too much.
There are three parts to the Family Kaiser Foundation report. The first is a general overview of the study and the key conclusions. The second report on hospitalization addresses the readmission rates and the recommendations to reduce. (By the way, it is estimated that about a third of residents are in the hospital at least once a year and of these residents half have two or more admissions. Minnesota is the lowest state in the country with only 7 percent of long stay residents with an acute admit.) The third report is on the financial incentives associated with readmissions. Each report has an executive summary which gets at the highlights.
Thank you, Nancy!