- Despite readmissions and post-acute care playing a larger role in hospitals' payments, two new United Hospital Fund studies uncovered persistent problems for patients with serious illnesses or hospitalized for a major surgery transitioning from a hospital to post-acute care.
One report, The Illusion of Choice: Why Decisions About Post-Acute Care Are Difficult for Patients and Family Caregivers, found that patients and family caregivers say they feel rushed when deciding on a skilled nursing facility during discharge.
The second report, Health Care Provider Perspectives on Discharge Planning: From Hospital to Skilled Nursing Facility, highlighted barriers for hospitals when transitioning patients.
The reports are the second and third part of UHF's four-part “Difficult Decision” year-long series into post-acute care. The New York State Health Foundation is sponsoring the initiative.
The first in the series reviewed post-acute care and issues with limited choices and decision-making. The final report will spotlight best practices and innovations connected to the transition to post-acute care.
In one of the new studies, authors Carol Levine, director of UHF's family caregiving initiatives, and Kristina Ramos-Callan, a UHF program manager, explored families feeling like they have little say over the post-acute care facility selection.
Levine said in a statement that she and Ramos-Callan heard from families about limited choices and lack of information about the quality of care at facilities. Hospitals also didn't prepare them "for the experience of being in a nursing facility."
Rather than a post-acute care facility's quality, families are often making decisions based on convenience. "In the end, location and access to transportation were often the pivotal factors in a patient's choice," Levine said.
The other study, written by UHF program manager Pooja Kothari and Joan Guzik, director of quality improvement for UHF's Quality Institute, explored the experiences of administrators and frontline staff at eight hospitals and five nursing homes in the New York area. The researchers found that "efficiency pressures, insurance constraints, authorization delays and regulations" often hamper the transfer.
"Hospital staff members are often under immense pressure to minimize the length of hospital stays while managing a complex process involving the need to align multiple stakeholders around the discharge plan," Kothar said in a statement. "The unfortunate reality is that the best solution may not be possible when high-quality, post-acute care facilities have few available beds."
CMS and other payers have increasingly looked to reduce the costs associated with post-acute care and readmissions. A recent New England Journal of Medicine report found that facilities in the Comprehensive Care for Joint Replacement bundled payment model experienced lower healthcare costs by reducing the percentage of episodes in which patients were discharged to post-acute facilities by 6%.
"Post-acute care services may be the easiest target for hospitals to decrease episode-level spending because it is often unclear when these services are beneficial or what intensity of post-acute care is most appropriate," the study researchers wrote.
The two new United Hospital Fund studies argued that educating families about their options and improving processes during the transition are other ways to improve post-acute care that go beyond the bottom line.