1. Interdisciplinary Team Role Play
Panel Discussion

4. Hospital Readmission Rate Reduction

5. Change in Readmission Rates
Comparison in change in Readmission Rates for Targeted Conditions and Nontargeted Conditions within 30 Days after Discharge.
Targeted conditions were acute myocardial infarction, heart failure, and pneumonia.
Points represent the mean rate weighted by the number of hospital index stays during the month. Solid lines represent the predicted rates. Slopes are the monthly change in the predicted rates, generated from a linear combination of regression coefficients.
October 2007 through March 2010 was the period before enactment of the Affordable Care Act (ACA);
April 2010 through September 2012 was the period of implementation of the Hospital Readmissions Reduction Program, which set financial penalties for hospitals that had higher-than-expected readmission rates for targeted conditions
October 2012 through May 2015 was the long-term follow-up period after penalties were initiated.

6. Hospital Readmission Penalties: Coming Soon to a Nursing Home Near You!
Journal of The American Geriatrics Society 64: , March 2016
Protecting Access of Medicare Act (PAMA) of 2014
Provisions for hospital readmission financial penalties for skilled nursing facilities
Start 2018
Similar to the Affordable Care Act mandate for hospital penalties
Opportunities for Improvement
Poor communication and care coordination between care settings
Including post- hospitalization and post-SNF care
Management of patients with greater acuity within the SNF

7. The Penalties
All SNFs experience a 2% reduction in reimbursement from CMS 2018
SNFs recoup by demonstrating acceptable risk-adjusted ratio and benchmark readmission rates as calculated by CMS
Any admission within 30 days post hospital discharge
Shared responsibility with hospital
Some exceptions – e.g. planned readmission, cancer treatment

8. Potential Solutions to the Problem of Readmissions
Practice core geriatric principles
SNF Interdisciplinary team involvement
Medical Director Involvement
Management plans for complex multimorbidity
Contingency planning, reduce high risk medications (Beers List), Antibiotic Stewardship
Define individual goals of care
Use available resources to assist with family communication
Involvement of all team members in transitions of care

9. Nursing Home Compare Five Star Rating System

11. Findings