Big Variations In Post-Discharge Care

Where a hospital discharges a surgical patient can have a significant correlation to whether they wind up being readmitted, according to UCLA researchers.

Their data, published in the most recent issue of the journal Medical Care, concluded that hospitals with shorter lengths of stays and higher readmission rates are more likely to refer patients to a skilled nursing facility as opposed to merely discharging them with home healthcare services.

Researchers examined the records of 112,620 patients treated at 217 hospitals in 39 states. Just under 20% received home healthcare, while 18.6% were sent to skilled nursing facilities or rehabilitation hospitals. But hospitals with the shortest lengths of stay discharged patients to outpatient facilities 24% of the time, versus 19.5% among those with longer lengths of stay. 

“These findings suggest that some hospitals may be using post-acute care as a substitute for inpatient care,” said Greg Sacks, M.D. the study’s lead author, a resident in general surgery at UCLA. “This might lead to patients being discharged from the hospital prematurely, which then results in higher readmission rates.”

According to the study, those hospitals more likely to send their patients to other inpatient facilities experienced a readmission rate of 24.1%. Among those hospitals less likely to send patients to skilled nursing or rehab facilities, the readmission rates dropped to 21.2%, a 14% differential. 

The study suggested that financial reasons may be driving hospitals to make certain decisions about how long they should keep patients and where they should discharge them.

The issue is a serious one both nationally and in California. The Medicare program spends about $62 billion a year on post-acute care, including more than $6 billion a year statewide – more than double the total of just a dozen years ago.

There have been a variety of studies suggesting that patients who are readmitted to hospitals within 30 days of discharge have significantly higher mortality rates than those who do not have to go back for more acute care.

Home care is not only cheaper for the Medicare program, but it can also be for the individual patient. Many non-surgical patients who have short hospital stays for observation who are than discharged to a nursing or rehab facility are often excluded from Medicare coverage in such a scenario, meaning they often have bills totaling thousands or tens of thousands of dollars.

“Our findings suggest that there is an urgent need to study the appropriate use of post-acute care to develop guidelines to assist postoperative discharge planning,” the report said. “The new evidence and guidelines based on that evidence would help ensure that patients receive the post-discharge care they need, while avoiding additional care they do not need.”