Leveraging Post-Acute Care Preferential Discharges to Improve Outcomes for Surgical Patients

INTRODUCTION: Preferential discharge of patients requiring post-acute care to high-quality skilled-nursing facility (SNF) has been shown to improve outcomes and decrease readmission for high-risk medical patients. Our aim was to describe the variation in readmission and post-acute care cost among the highest-volume SNFs to guide health system stakeholders and payers in creating preferential SNF networks for surgical patients. METHODS: We performed a retrospective cross-sectional analysis of adults who underwent elective hip/knee replacement, colectomy, coronary artery bypass grafting (CABG), hip fracture repair, and polytrauma who were discharged to a SNF between January 2015 and December 2019 using multipayer claims data (Medicare, Medicaid, private insurance) from the Michigan Value Collaborative (MVC). Our outcomes were 30-day readmission and 90-day price-standardized post-acute care payment for the 30 highest volume SNFs to demonstrate the feasibility of analysis for a healthcare network. Risk-adjustment accounted for patient factors and the occurrence of complication. RESULTS: A total of 23,442 patients were included and adjusted 30-day readmission rate was 16% to 24%. There was a significant difference in adjusted procedure-specific readmission rate and variation in outcomes between individual SNFs for each procedure. Variation in post-acute care use varied 2.5-fold ($6,288 to $15,520) for CABG, 1.5-fold ($12,216 to $7,754) for elective joint replacement, and 1.4-fold for trauma admission ($19,481 to $14,034). For uncomplicated hip fracture, post-acute use varied 1.91-fold ($21,132 to $11,017) (Figure).FigureCONCLUSION: There is significant variation in readmission and post-acute care use across the highest-volume SNFs for surgical patients. These findings suggest that developing preferred SNFs for surgical patients should consider procedure type and may prove useful in decreasing the variation in outcomes.