Hospitals Using Bundled Payment Report Reducing Skilled Nursing Facility Use And Improving Care Integration

Area of Science:

• Health Services Research
• Healthcare Management
• Post-Acute Care

Background:

• Medicare's bundled payment models aim to enhance care quality and manage costs post-hospitalization.
• Skilled nursing facility (SNF) utilization is a key area within these models, yet hospital strategies remain unclear.

Purpose of the Study:

• To investigate how hospitals participating in Medicare bundled payment initiatives are strategically managing skilled nursing facility (SNF) use.
• To identify organizational approaches to optimize post-discharge care and SNF integration.

Main Methods:

• Semistructured interviews were conducted with 22 hospital and health system executives/administrators.
• Participants were involved in Medicare's Comprehensive Care for Joint Replacement (CJR) or Bundled Payments for Care Improvement (BPCI) initiatives for joint replacements.

Main Results:

• Hospitals adopted two primary strategies: reducing SNF referrals through home-based care facilitation and enhancing integration with SNFs via preferred networks.
• Fifteen participants formed SNF networks to influence quality and costs, employing strategies like EHR sharing, embedded providers, and data platforms.

Conclusions:

• Hospitals are actively developing distinct strategies to manage post-discharge care, focusing either on reducing SNF use or increasing SNF integration.
• Further research is needed to evaluate the impact of these evolving discharge practices on patient outcomes and care quality.