Synopsis
Most hospital patients who require care from a nursing facility following their discharge receive no information about the quality of available facilities, according to interviews with patients and medical staff. With hospitals now held partly responsible for their patients’ care after discharge, Medicare will likely need to amend or clarify its rules to encourage hospitals to recommend higher-quality facilities to their patients.
The Issue
"We found that patients are provided only with lists of [nursing facilities] and that hospital staff members do not give patients readily available data on quality that could aid them in selecting higher-quality facilities."
Under the Affordable Care Act, hospitals face financial penalties if their Medicare patients are readmitted following release. Hospitals therefore have an incentive to steer patients who require postacute care after discharge to higher-quality nursing homes and rehabilitation facilities, where they are less likely to need hospital readmission.
Although patients or family members typically choose a nursing facility while being discharged from the hospital, researchers know very little about how they select one or about the role that hospital staff play in guiding patients’ choices. With Commonwealth Fund support, a research team examined how patients requiring postacute care choose a nursing facility and what role hospitals play in the selection process.
Key Findings
- Patients were provided little information about nursing facilities. Hospital staff members typically provided patients with a list of names, addresses, and telephone numbers of nearby facilities, but no information on the quality of care at each facility. Of 98 patients interviewed, only four reported receiving any information about facility quality.
- Hospital staff members focus on respecting patients’ choice. Hospital staff reported providing patients with lists of nursing facilities containing only minimal information because they believed that patient choice laws forbid them from influencing the selection process. This belief often stems from direct instructions that hospital executives and legal departments provide them.
- Patients typically select the nursing facility closest to their home. Given the limited information they receive about each nursing facility, patients tend to choose the closest option by default. However, three-quarters of the patients interviewed said that they would have been willing to travel farther if a better facility had been recommended. Most patients found the selection process overwhelming and would have appreciated more guidance in choosing a nursing facility.
- One hospital stood out for providing patients with informed choice. Staff at one hospital, which participated in an accountable care organization, reported how they subtly nudge patients toward their hospital’s network of preferred nursing facilities. Like the other hospitals studied, this one provides patients with a list of all nearby nursing facilities. But unlike other hospitals, it places high-quality facilities at the top of the list and color-codes them for easy identification.
The Big Picture
Hospitals are not providing patients with the information they need to choose higher-performing nursing facilities, the researchers say. While federal statutes protect the right of Medicare patients to choose their own providers, nothing in the law prevents hospitals from helping patients make an informed choice. The authors recommend the adoption of proposed changes to Medicare’s conditions of participation to require hospitals to share data on facility quality with patients. Alternatively, the Centers for Medicare and Medicaid Services could clarify the limits on what hospitals may do to aid patient choice. Adopting a less strict approach to patient choice, the authors argue, would allow patients to make better, more-informed choices that would lead to improved outcomes for patients and hospitals alike.
About the Study
The research team interviewed 138 staff members at 16 hospitals and 25 nursing facilities across eight U.S. markets. The team also interviewed 98 patients admitted to 14 of the nursing facilities in five of those markets.
The Bottom Line
Hospitals are not providing patients who need care in skilled nursing facilities with data that would allow them to select a high-quality provider, even though hospitals are held partly responsible for their patients’ care post-discharge. Hospitals should provide these data to help patients make a more informed choice.