Skilled nursing facilities that employ fewer registered nurses send patients back to hospitals or emergency rooms more often, a new federal report found.
Understaffed nursing homes, measured by registered nurse hours per resident day, sent 24% of their patients back to the hospital within 30 days of entering SNFs in 2018, according to a new Office of Health. Government Accountability (GAO) report. The readmission rate was 21% among nursing homes that employed more nurses, even after adjusting for differences in medical conditions. That difference translates into 2,265 more hospital readmissions in facilities with fewer nurses. That trend persisted through 2019. Readmissions decreased as staffing levels increased.
“This is important because the Medicare program is spending an estimated $ 5 billion across all SNFs regardless of staffing levels on these incidents, and research has shown that reducing hospital readmissions is important to improving the quality of care. and patient safety, “said Jessica Farb, managing director of GAO’s healthcare team and lead author of the report. “The current mechanism aimed at reducing hospital readmissions among SNF patients may not include a sufficient incentive for SNFs to increase their staff to avoid such critical incidents.”
CMS reduces up to 2% of certain Medicare payments to SNFs that exceed the thresholds for the readmission rate. Nearly 10,000 of the 15,202 SNFs in the program saw such payment declines during fiscal year 2020, while about 2,900 higher-quality SNFs received payment increases of up to 3%, according to CMS.
Congress should consider ordering HHS to implement more aggressive sanctions, recommends the GAO. Meanwhile, CMS should report weekend declines in nursing staffing levels rather than simply adding staffing data through Care Compare and should set minimum nursing staffing thresholds that ensure quality care, advises the agency. research. Average skilled nursing staff hours decrease about 40% on weekends, but CMS does not directly report this information, the GAO found.
Policy experts came to similar conclusions. RN’s weekend staffing per resident day was 42% less than Monday through Friday staffing time, according to a Harvard Medical School analysis of data spanning from April 2017 to March 2018.
“Adverse events occur disproportionately on weekends when nursing homes are often understaffed. However, the federal Care Compare website only requires facilities to report their overall staffing averages and does not require nursing homes to report your weekend staff on the website, “said David Grabowski, a professor of health policy at Harvard Medical School and a co-author of that study.
“This GAO report makes important recommendations to add weekend staff to Care Compare and also hold nursing homes accountable when understaffing leads to costly transfers to the hospital and emergency department,” said Grabowski.
The COVID-19 pandemic severely affected nursing homes, as evidenced by high case counts and a reduction in the number of jobs.
Employment in skilled nursing is recovering more slowly than in the healthcare industry in general. Nursing homes cut 1,500 jobs from June to July, and SNF employment has declined every month since the outbreak began in the US last year. Up to 94% of nursing homes experienced staff shortages in the past month, according to a June survey.
A few months before the pandemic, CMS executed a massive restructuring of the SNF sector. Thousands of physical, occupational and speech therapists had their hours reduced or were laid off around October. January 1, 2019, when a new payment model came into effect.
Policy experts have advocated a review of nursing home reimbursement and staffing models to limit turnover and minimize pay disparities.
About 20% of nursing home residents are short-stay patients coming from the hospital, mostly Medicare beneficiaries recovering from surgery. Those patients, who are more lucrative than Medicaid enrollees, have virtually disappeared for long periods since the pandemic began. The rest are long-term residents, largely covered by Medicaid, who are more likely to have cognitive problems.
Nursing homes are left with residents where they primarily lose money, which has pushed some facilities to the brink as costs for staff and supplies rise, experts said.