ACO hospitals reduced readmissions from SNFs more quickly

While all hospitals have reduced readmissions of skilled nursing facility (SNF) patients, those affiliated with accountable care organizations (ACOs) did so more quickly, according to a study published in the January 2017 issue of Health Affairs.

Authored by Ulrika Winblad, PhD, a public health professor at Sweden’s Uppsala University and Brown University researchers, the study examined readmission rates for all fee-for-service Medicare beneficiaries who were discharged from hospitals to SNFs. Some 220 hospitals involved in the Medicare Shared Savings Program or Pioneer ACO model were compared to more than 1,800 non-ACO hospitals in the same metropolitan area. The goal was to determine whether ACO-affiliated hospitals improved rehospitalization rates for FFS Medicare beneficiaries discharged to SNFs.

Over the time period examined (2007 to 2013), all hospitals reduced readmissions, as the Affordable Care Act enacted penalties for excess rehospitalizations. But while non-ACO hospitals reduced readmissions from SNFs by an average of 13.1 percent, MSSP hospitals lowered them by 17.7 percent, while Pioneer ACO hospitals reduced them by 14.9 percent.

“The reductions suggest that ACO-affiliated hospitals are either discharging to the nursing facilities more effectively compared to other hospitals or targeting at-risk patients better, or enhancing information sharing and communication between hospitals and skilled nursing facilities,” Winblad and her coauthors wrote. “Policy makers expect that reducing readmissions to hospitals will generate major savings and improve the quality of life for the frail elderly.”

Researchers didn’t only rely on 30-day readmissions, which were more likely to be caused by the SNF. The study differentiated quick admissions within the first three days of discharge and found both rehospitalizations declined in ACO-affilated hospitals.

What the researchers didn’t examine was how the ACOs hospitals did better, whether it was better care coordination with SNF or changing their strategies around more at-risk patients. They did say the dual incentive of avoiding negative reimbursement adjustments and keeping more of a bundled payment appears to work as motivation for reducing readmissions.

“Hospitals have historically had no incentive to coordinate care management efforts with post-acute providers," coauthor John McHugh, now an assistant health policy professor at Columbia University, said in a statement. "This highlights one area in which the ACO incentive structure may be working to improve outcomes for skilled nursing facility patients."