Reducing the re-hospitalization of nursing home residents is a constant and important public policy goal. At present, the goal is largely met by imposing financial sanctions against hospitals and skilled nursing facilities (SNFs) when residents are re-hospitalized. A better way of reducing re-hospitalizations of nursing home residents would be ensuring that residents get the care they need in the SNFs.
A new study of residents in traditional Medicare who were discharged to nursing homes between January 2012 and October 2014 finds that residents who were not seen by a physician or advanced practitioner (10.4% of the total) had a higher likelihood of a poor outcome – return to the hospital, death, or failure to return successfully to the community. Ensuring that physicians or other advanced practitioners see residents after they are admitted to a nursing home could lead to fewer re-hospitalizations.
For many decades, inadequate nurse staffing levels have been correlated with re-hospitalizations of residents. A three-year study of non-clinical factors that contributed to the re-hospitalization of residents, published thirty years ago, found “insufficient and inadequately trained nursing staff” who could not meet residents’ complex health care needs as a cause of residents’ re-hospitalizations. A paper by Kaiser Family Foundation and Lake Research Partners in 2010 confirmed earlier findings about the multiple causes of re-hospitalizations and the need to increase nurse staffing levels in nursing facilities.
It is time to address the actual causes of re-hospitalizations of nursing home residents by providing better health care in SNFs.
April 18, 2019 – T. Edelman
 Affordable Care Act, §3025, 42 U.S.C. §1395ww(q), created the Hospital Readmissions Reduction Program.
 Protecting Access to Medicare Act (2014), §215, 42 U.S.C. §1395yy(h), created a Value-Based Purchasing Program for SNFs. Beginning in fiscal year 2019 (services furnished on or after Oct. 1, 2018), the Centers for Medicare & Medicaid Services reduces Medicare payments to SNFs that have high rates of re-hospitalizations of their residents.
 Kira L. Ryskina, et al, “Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities,” Health Affairs 38, No. 4 (2019): 528-536, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05458 (abstract).
 Center for Medicare Advocacy, “More Nurses in Nursing Homes Would Mean Fewer Patients Headed to Hospitals” (CMA Alert, Mar. 10, 2011), https://www.medicareadvocacy.org/more-nurses-in-nursing-homes-will-mean-fewer-patients-headed-to-hospitals/.
 J.S. Kayser-Jones, Carolyn L. Wiener, and Joseph C. Barbaccia, “Factors Contributing to the Hospitalization of Nursing Home Residents,” The Gerontologist (1989).
 Michael Perry, Julia Cummings (Lake Research Partners), Gretchen Jacobson Tricia Neuman, Juliette Cubanski (Kaiser Family Foundation), “To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care facility Residents; A Report Based on Interviews in Four Cities with Physicians, Nurses, Social Workers, and Family Members of Residents of Long-Term Care Facilities (Oct. 2010), https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8110.pdf.