Variability in skilled nursing facility screening and admission processes: Implications for value-based purchasing.

Area of Science:

• Gerontology
• Health Services Research
• Healthcare Management

Background:

• Hospitalized older adults increasingly require skilled nursing facility (SNF) care post-discharge.
• Current SNF screening and evaluation processes for new admissions are not well understood.
• Understanding these processes is crucial for improving postacute care value.

Purpose of the Study:

• To investigate how SNF clinicians evaluate hospitalized older adults for admission.
• To identify limitations and benefits of current SNF admission practices.
• To analyze these practices within the context of value-based payment reforms.

Main Methods:

• Semistructured interviews were conducted with 18 clinicians across three SNFs.
• Participants included physicians, nurses, therapists, and liaisons.
• Data were analyzed using a general inductive theme-based approach.

Main Results:

• SNF screening and admission processes showed significant variability.
• External pressures included poor medical documentation transfer, hospital staff's lack of SNF understanding, and rapid hospital discharge incentives.
• SNFs adapted by accessing electronic records, offering inpatient consultations, and selectively admitting patients.

Conclusions:

• SNF admission practices are influenced by internal and external factors, impacting equitable access to care.
• Value-based purchasing models are a significant driver of these behaviors.
• SNFs need greater agency in hospital relationships and refined screening to align patient needs with facility capabilities.