Findings from a self-examining study suggest that sending patients home rather than to an acute care facility after major surgery showed no corresponding increase in readmission rates.
The study was performed by NYU Langone Medical Center and published recently in JAMA Internal Medicine.
A media release from NYU Langone Medical Center explains that, in 2012, NYU Langone began participating in a Medicare pilot program under the Affordable Care Act called Bundled Payment for Care Improvement. Under this program, hospitals and physicians deliver all services for an episode or “bundle” of care in return for a single lump sum payment, for patients undergoing either cardiac valve replacement, major joint replacement of the lower extremity, or spinal fusion. An episode of care typically includes a hospital stay plus a 90-day recovery period.
As part of the program, one intervention NYU Langone pursued was to send more patients home for postsurgery recovery than to an acute care facility, such as a skilled nursing facility.
Study researchers examined Medicare claims data on 4,664 patients for a nearly 3-year baseline period before the program began, a period during the program’s preparation, and a “risk-bearing” period after the program launched, the release continues.
They found that NYU Langone achieved a drop of 49 percentage points in patients discharged to post-acute care facilities after cardiac valve surgery and a drop of 34 percentage points for those undergoing lower-extremity joint replacement surgery, with no corresponding increase in readmission rates. Readmission rates were similarly stable in patients undergoing spinal fusion, for whom post-acute care facility rates were unchanged. The study was not able to evaluate outcomes like functional status or whether the patients fully recovered from surgery, the release explains
“As clinicians, we often feel that discharging patients to an acute rehabilitation facility may help them recover better and prevent them from returning to the hospital,” says the study’s senior author, Leora Horwitz, MD, MHS, associate professor in the Department of Population Health and director of the Center for Healthcare Innovation and Delivery Sciences at NYU Langone, in the release.
“But we did not see any increase in readmissions after our clinicians began sending more patients directly home. These results may give surgeons greater confidence in discharging patients directly home instead of to a facility, where care is more costly and potentially more disruptive to the lives of patients and families, she adds.
[Source(s): NYU Langone Medical Center, Newswise]
