Frequent post-acute care use may equal more readmissions

HCPRO Website, March 22, 2016

Some hospitals may be referring patients too quickly to post-acute facilities—which is reducing their average length of stay but negatively affecting their readmission rates, according to a February 2016 study published in the American Publich Health Association's journal.

Researchers looked at data from 217 hospitals in 39 different states. The analysis included information on more than 112,000 patients from the national surgery registry, Medicare claims, and the American Hospital Association annual surveys between 2005 and 2008.

Researchers used the data to look at whether there was a link between post-acute care use and:

  • Mortality rates
  • Complication rates
  • Readmissions
  • Lengths of stay

They found that hospitals refer patients to inpatient facilities at very different rates ranging from less than 3% of patients to 40% of patients. The same is true of prescriptions for home-health services, which ranged from 3% of patients up to 58% of patients.

While researchers found no link between the post-acute services hospitals used and outcomes such as complications or post-operative deaths, they did see an effect on readmissions and length of stay. Facilities that used post-acute services more often had shorter lengths of stay and more readmissions.
“These findings suggest that some hospitals may be using post-acute care as a substitute for inpatient care. This might lead to patients being discharged from the hospital prematurely, which then results in higher readmission rates,” said the study’s lead investigator, Dr. Greg Sacks, a general surgery resident at UCLA, in a written release.

What can help solve the problem? Possibly the addition of specific guidelines for surgeons, advising them on post-acute options for patients—something that doesn’t currently exist. The report also says that the financial incentives some health care plans provide to hospitals that discharge patients more rapidly could also be contributing to the problem.

“Our findings suggest that there is an urgent need to study appropriate use of post-acute care to develop guidelines to assist postoperative discharge planning. 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 that they do not need.”