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Impact of Skilled Nursing Facility (SNF) Network Participation and Transitional Care Management on SNF Length of Stay
Amy W Baughman1,2,3, Michelle L Frits4, Kathleen Strand3
1Massachusetts General Hospital, Boston, Massachusetts, USA.
Background:
This evaluation highlights potential strategies to decrease unnecessary skilled-nursing facility (SNF) utilization. We evaluated the impact of a SNF network and transitional care management program (TCM) on SNF length of stay (LOS) for beneficiaries in a Medicare Shared Savings Plan (MSSP) Accountable Care Organization (ACO).
Methods:
Design: Retrospective claims-based cohort study.
Setting:
Mass General Brigham (MGB) is a large integrated healthcare system. MGB Population Health develops value-based strategies to improve performance in shared savings ACOs, including nearly 130,000 Medicare beneficiaries.
Participants:
Adult MSSP ACO beneficiaries admitted to a SNF between January 2022 and September 2023. Exclusions included death, admission to hospice or long-term care hospital; patients were excluded from the SNF LOS analysis if they experienced hospital readmission.
Intervention:
The MGB SNF Collaborative Network included 60 SNFs in 2022 and 63 SNFs in 2023 based on quality metrics and collaboration with MGB hospitals. The TCM Program included 14 care managers, who optimize SNF utilization for beneficiaries discharged to MGB Network SNFs.
Main Outcome And Measure:
The primary outcome of interest was SNF LOS. We conducted univariate regression analyses with variables that could impact SNF LOS; covariates with a p value ≤ 0.1 were included in the multivariable regression model. We assessed for collinearity with model diagnostics, including variance of inflation measures.
Results:
Multivariable regression demonstrated that admission to a SNF network facility without TCM was associated with a reduction in LOS of 4 days, and admission to a SNF network facility with TCM resulted in a 5-day LOS reduction. Based on LOS reduction, we estimate a programmatic impact of $556 per beneficiary per day [1], with savings of $2224-$2780 per admission.
Conclusion:
SNF networks and care management can mitigate unnecessary SNF utilization, offering a high-value approach for ACOs and other value-based care organizations.
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