Home Health & Hospice Week

Patients may overwhelmingly prefer to receive care at home after a hospital discharge, but the same may not be the case for the hospitals discharging them, following a new study.

Researchers led by Kevin Griffith at Vanderbilt University Medical Center tracked hospital readmission rates for acute myocardial infarction, heart failure, and pneumonia patients, says a study published in the July issue of the journal Health Affairs. Thirty-day readmission rates were lower for hospitals that were located in areas with more primary care physicians, skilled nursing facility beds, licensed nursing home beds, or that operated a palliative care service.

On the other hand, “hospitals with a greater local supply of home health agencies or nurse practitioners were associated with increased readmissions,” the journal notes. The study doesn’t speculate on the reasons for the outcome, but the lack of 24/7 in-person oversight and patients’ opportunities for noncompliance with treatment plans in the home seem like obvious reasons at first glance.

The finding may not be great news for HHAs, which would prefer hospitals to send referrals their way rather than to SNFs. “Hospitals should take a more active role to develop post-discharge care options in their communities,” the study authors suggest. “For instance, hospitals could start their own palliative care service or steer patients towards post-acute care options with lower readmission rates,” says a Vanderbilt release about the study.

The study finding may be good news for hospices, however, which of course furnish palliative care.

Meanwhile, Griffith would like to see the Centers for Medicare & Medicaid Services use better risk adjustment when penalizing hospitals’ pay based on readmission rates. “We need to start accounting for the fact that some areas simply have more resources than others, and that is going to affect patient outcomes,” he says in the release. “Congress’ intent was to penalize hospitals based on the quality of care they provide, not the communities they serve.”