Files
Abstract
ABSTRACT The impact of 30-day readmissions is a challenging crisis from both cost and quality perspectives. From a quality perspective, for nearly four decades, Medicare beneficiaries have had the Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare (NHC) website to use as a tool to identify quality rating information for any certified skilled nursing facilities (SNFs) in the United States (US). Using the 5-star rating system (5-star being high quality and 1-star being poor quality), the aim of CMS through its NHC website is to inform and encourage patients and families needing inpatient rehabilitation services to select the highest quality bed available. In recent years, 30-day readmissions have been included as a quality measure for hospitals and skilled nursing facilities. From a cost perspective, with 30-day readmission costs for Medicare beneficiaries in the billions, the urgency to improve SNF quality and reduce costs was ushered in under the Affordable Care Act (ACA) (2012). As a quality indicator that is factored into the overall SNF quality star rating, CMS has made reducing 30-day readmissions a national priority. The ACA allows CMS to reward SNFs with low 30-day readmission rates, while penalizing SNFs with excessive 30-day readmission rates. As of this writing, seventy-three percent of US SNFs have been penalized for excessive 30-day readmissions. While there may be quality of care differences between lower-rated and higher-rated SNFs based on star ratings, this study finds that Medicare beneficiaries or their families cannot use star ratings to determine the probability of being readmitted into a hospital within 30 days. This study concludes that the high 30-day readmission rates, especially from high-performing SNFs, may be caused by NHC. Using the NHC website, patients who prefer to transfer to the highest quality bed available will select higher star rated SNFs over lower star rated SNFs. According to the data used for this study, 5-star SNFs were just as likely, and in some cases more likely, to have patients readmitted within 30 days as 1-star SNFs. As the US population lives longer with chronic illnesses and diseases, this study suggests that 30-day readmission probabilities may be more closely associated with the number of patients in the facility, and less with the 5-star quality rating that patients may use to inform their SNF selection decision. Using data from the Nursing Homes Including Rehab Services files on the CMS.gov website, this longitudinal retrospective study will examine the relationship between the SNF 5-star quality rating and 30-day readmission rates for 2017 – 2022. This study, using secondary data to create regression analysis, correlation, simple comparisons, charts, and graphs, assigns the SNF star rating as the independent variable and the SNF readmission rate as the dependent variable. The strength of this study is its scope and reach. This study is a national study of all certified SNFs operating during the study period. In 1965, perhaps the former almshouses were the best facilities available for Medicare beneficiaries needing short-term rehabilitation services, but the needs of today’s population may call for an alternative. Rather than combining Medicare beneficiaries needing short-term rehabilitation facilities with long-term SNF residents, creating facilities dedicated to short-term rehabilitation may be a viable alternative.