Patients Don't Receive Adequate SNF Quality Data Upon Discharge, Study Finds

Patients discharged from hospitals may not be fully equipped with the information they need to select a high-quality skilled nursing facility (SNF), according to a new study.

While prior studies have shown that selection of long-term care facilities often depends on word of mouth and facility location, little evidence exists on the factors contributing to postacute care decisions. In this study, researchers interviewed hospital and SNF staff, as well as patients in SNFs to investigate how patients decide on a location for their postacute care after leaving the hospital. Their findings were published in the recent issue of Health Affairs.

Interviews gathered feedback about the hospital discharge and SNF admission processes from staff at 16 hospitals and 25 SNFs. The interview subjects included chief medical officers, hospitalists, discharge planners, SNF administrators, nursing directors, and more. The locations were chosen to be representative of all US markets and included facilities with varying characteristics. The researchers also interviewed 98 patients at some of the SNFs.

The most striking finding was that the hospital staff members offered a simple list of SNFs to patients upon discharge, lacking context on quality or other data beyond facility names and addresses. Patients confirmed these accounts, with just 4 reporting they had received quality information about such facilities or were told where they could find such data. Only 1 discharge planner said they directed patients to the Nursing Home Compare website, which offers information to help patients and families make an informed decision.

Delving deeper, the researchers explored the reasons why hospital staff refrained from providing SNF quality data to patients. Many reported that their hospital’s legal advisers had told them not to provide any recommendations or quality data, on the basis that it could violate Medicare’s patient choice laws.

One discharge planner summed it up by explaining, “CMS requires patient choice, so we literally had a whole list of everything that’s within whatever the radius is that the family’s looking for ... provided to them.”

With this lack of information, patients who are handed a list of SNFs and locations tended to select the nearest facility. They told the researchers that they would have appreciated recommendations from their discharge planner because they are reported that selecting a SNF had been an “overwhelming” experience.

A notable exception to these findings came from a hospital participating in an accountable care organization (ACO), which also provided patients a list of all local SNFs but placed the highest-quality facilities in green at the top of the list. The hospital monitored SNF quality through quality questionnaires and site visits, and said that participating in an ACO allowed them to create a network of preferred SNFs that could help patients make a decision.

Considering that hospitals are beginning to be held accountable for patients’ postacute care and outcomes, the study authors found it surprising that most of the ones they examined refused to direct patients to higher quality facilities out of concerns about patient choice. Amending CMS policies to allow and encourage hospitals to assist patients in choosing a SNF could help remedy this problem, they wrote.

“A system based on quality reporting and competition for patients cannot succeed if patients do not have the data necessary to make an informed choice,” the researchers concluded. “Hospitals should provide these data and help patients and their families understand them.”