SNF patients could be discharged earlier without compromising quality, study says


A May 3 Health Affairs study finds patients of skilled nursing facilities can be safely transitioned to home care earlier in the recovery period, indicating the facilities are not used efficiently.

While the study was limited in its ability to tell providers how much to reduce SNF use by and whether earlier discharge affected patients’ “functional recovery,” it highlights that reducing the length of stays has not caused worse health outcomes for patients receiving post-acute care.

The study compared the outcomes of patients grouped by their exposure to cost-sharing, with patients who have to pay cost-sharing likelier to be discharged earlier in their stay than those with supplemental insurance, in order to see if early discharge affected quality.

“We were open to the possibility that some of these patients would be deemed discharged prematurely and have some adverse consequences as a result of leaving the SNF,” said Brian McGarry, assistant professor at the University of Rochester, who led the study. But to his surprise the study did not find any evidence of that.

“Our findings are consistent both with evidence that SNF stays are often excessively long and with the early success of risk-bearing providers in curtailing SNF stays without adverse consequences evident so far,” the authors wrote.

McGarry says that the study should provoke some thought around the way Medicare cost-sharing is structured to target lower income patients, forcing providers and patients to make decisions surrounding care based on rising co-payments.

“Patients should not be forced to make suboptimal decisions about their care because they cannot pay a hefty cost when they reach an arbitrary day in their SNF stay,” said McGarry. He said that many patients who were ready to be discharged earlier stayed either because short-stay patients tend to be more lucrative for SNF’s or patients feared high out-of-pocket expenses.