Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities.
John P McHugh, Andrew Foster, Vincent Mor, Renée R Shield, Amal N Trivedi, Terrie Wetle, Jacqueline S Zinn, Denise A Tyler
Author Information
John P McHugh: John P. McHugh (john.mchugh@columbia.edu) is an assistant professor in the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, in New York City.
Andrew Foster: Andrew Foster is a professor of economics at Brown University, in Providence, Rhode Island.
Vincent Mor: Vincent Mor is a professor of health services, policy, and practice at the Brown University School of Public Health and a health scientist at the Providence Veterans Affairs Medical Center.
Renée R Shield: Renée R. Shield is a professor in the Center for Gerontology and Healthcare Research, Brown University School of Public Health.
Amal N Trivedi: Amal N. Trivedi is an associate professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health.
Terrie Wetle: Terrie Wetle is dean of the Brown University School of Public Health.
Jacqueline S Zinn: Jacqueline S. Zinn is a professor in the Department of Risk, Insurance, and Healthcare Management at the Fox School of Business and Management, Temple University, in Philadelphia, Pennsylvania.
Denise A Tyler: Denise A. Tyler is a senior research health policy analyst in the Aging Disability and Long Term Care program at RTI International in Waltham, Massachusetts.
Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009-13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March-October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice.
