Hospitals Using Two Strategies to Up Quality, Lower Costs

THURSDAY, Sept. 6, 2018 -- Hospitals receiving bundled payments are reducing skilled nursing facility (SNF) use and improving care integration to improve quality and control costs, according to a report published in the August issue of Health Affairs.

In an effort to better understand how hospitals are trying to improve quality and control costs, Jane M. Zhu, M.D., from University of Pennsylvania in Philadelphia, and colleagues conducted semi-structured interviews with an executive or administrator in each of the 22 hospitals and health systems participating in Medicare's Comprehensive Care for Joint Replacement model or its Bundled Payments for Care Improvement initiative for lower extremity joint replacement episodes.

The researchers identified two major organizational responses. First, hospitals are reducing SNF referrals, using risk-stratification tools, patient education, home care supports, and linkages with home health agencies to encourage discharges to home. To enhance integration with SNFs, hospitals report establishing networks of preferred SNFs to exert influence over SNF quality and costs. A second strategy includes increasing coordination through shared access to electronic medical records, embedding providers across facilities, hiring dedicated care coordination staff, and creating platforms for data sharing.

"As hospitals presumably move toward home-based care and more selective SNF referrals, more evidence is needed to understand how these discharge practices affect the quality of care and patient outcomes," the authors write.

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