Skilled Nursing Facility/Inpatient Rehabilitation Facility Discharges and TJR Readmission Rates

In an effort to reduce readmissions, hospital staff can choose to send a patient to a post-acute care provider for additional assistance during total joint replacement (TJR) recovery. Last week’s Research Corner explored the association of home health care discharge rates and readmission rates. VHHA found no statistically significant correlation between the two.

The second largest discharge category for Medicare TJR patients is skilled nursing facilities (SNF) or inpatient rehabilitation facilities (IRF). A summary of the discharge distributions of all TJR admitted and readmitted patients reveals a larger distribution of SNF or IRF discharges (see Figure 1 below). As you can see, one-third of all Medicare discharges for TJR are sent to a SNF or IRF. But nearly half of the readmitted patients (44 percent) were initially discharged to an SNF or IRF.


The next step in the analysis focused on hospital-specific data. If Medicare patients discharged to an SNF or IRF are more likely to return within 30 days, then do hospitals with higher SNF/IRF discharge rates have higher readmission rates? VHHA tested this claim by using logistic regression to plot each hospital’s SNF/IRF health care discharge rate in relation to their risk adjusted readmission rate (RSRR). We used the RSRR to control for patient acuity. The results: No statistically significant correlation was found (see Figure 2 below). What does this finding mean for clinicians? As we found with the home health discharges, it is not the discharge location that determines if patients return to the hospital within 30 days. The determining factor is likely the complexity of care associated with patients’ ongoing chronic diseases such as diabetes, hypertension, COPD, and the like. Most patients that return to the hospital have three or more chronic conditions, take multiple medications, have recurring testing schedules, and dietary restrictions. Their care needs to be coordinated to reduce readmissions. One care coordination initiative to reduce readmissions is to encourage partnerships among key stakeholders, including hospital staff, the patient and their caregivers, and the SNF/IRF providers that would allow all parties to maintain ongoing investment in the overall post-op success of the patient. The goal for each remains the same: coordinate care for discharge protocols, appropriate transfers and handoffs, and overall patient post-op rehabilitation to ensure the patient does not need to return to hospitals via the emergency department. (3/4)

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