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Creating a More Effective Relationship Between SNFs and Physicians

The high rate of hospital readmissions from Post-Hospitalist Facilities during the first 30 days after discharge is under scrutiny because of its high cost to both Medicare and patient care. Significant advances can be made by improving relationships between SNFs and physicians. Even better for patient care appears to be having a physician on staff at the post hospitalist facility.

In 2010, one in four patients admitted to an SNF were readmitted to a hospital within the first 30 days of their stay. The typical readmitted-patient’s hospital care costs 33% more than the average hospital patient’s care. Those two statistics added up to a whopping $4.3 billion bill for Medicare in 2010.post-acute care providers

That’s the financial impact to Medicare.

For patients, the impact of these, often avoidable, readmissions can be traumatizing – emotionally and physically. The disruption in patient care not only causes distress on the family and the patient, it can lead to delirium in the patient. The deconditioning that occurs during these transitions can lead to bedsores and incontinence requiring catheterization.  Polypharmacy, risk of acquired infections, falls, weight loss and poor nutrition are all increased in these patients.

Getting doctors in the building more often can significantly cut the number of 30-day readmissions. In the existing model it isn’t uncommon for a single physician to oversee as many as five post hospitalist facilities. This, in addition to patient care in their own practices and hospital rounds, can lead to as few SNF visits as one every two weeks. This leads to readmissions that are preventable, avoidable or unnecessary except that less qualified staff are there to make critical patient care decisions.

Having a post hospitalist physician has cut the 30-day readmission rate to 8% from a national average of 20% in 18 different Sacramento area SNFs. Since a physician can provide immediate patient care there is much less need to transfer patients to the hospital for care.

Additionally, having a post hospitalist physician or advanced practice nurse on staff has been proven to lead to improved patient care by other SNF staff too. The ability to interpret a patient’s confusing medical records is another benefit that can positively impact the outcome of patient care in an post hospitalist setting.

The cost of having a post hospitalist doctor at an SNF can be offset by the effects it has. Shortened length of stays, low complication rates and less readmissions all save money as well as prompt a hospital to make referrals to such a facility therefore keeping occupancy rates up.

New rules established by the Affordable Healthcare Act not only requires SNFs to improve their 30-day readmission rates, it establishes fines for not doing so, by decreasing their Medicare payments. That penalty is being incrementally instated. SNFs started by paying a 1% penalty, the full 3% penalty will take effect in 2017.

In settings where a post hospitalist doctor is not feasible, steps to improve communication between the discharging hospital and the receiving SNF can significantly improve patient care. This is especially true in the case of medications, since often times, the information is not automatically transferred with the patient, significantly increasing the chance for medication errors.

Hospitals and post hospitalist facilities can also work together to improve these high, and costly, rates of readmission by working more closely with one another. A hospital discharging all of their patients requiring skilled nursing care might discharge to a single post hospitalist facility, therefore creating a closer, and more consistent, working relationship. Post hospitalist facilities can also work with patients from just one hospital only for the same reasons.

There are less drastic steps than can be implemented to improve SNF patient care and lessen 30-day-readmissions. Providing doctors with access to the facility’s electronic health records would give immediate access to a patient’s information even when off site. Going digital can allow the physician to build clinical protocols that can be measured, evaluated and shared. Improvement to communications can be made by training staff to be concise and prioritize the information for the doctor.

Are you looking to improve readmission rates at your healthcare facility? General Medicine has worked with some of the nation’s top hospitals. We can implement the right staff and procedures to create a more streamlined process and decrease readmission rates. Contact General Medicine The Post Hospitalist Company today to learn more about our post-hospitalist program.


Tom Prose