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J Am Geriatr Soc. 2016 Mar;64(3):614-8. doi: 10.1111/jgs.14021.

Hospital Readmission Penalties: Coming Soon to a Nursing Home Near You!

Carnahan JL1,2, Unroe KT1,2,3, Torke AM1,2,3,4,5.

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Center for Aging Research, Regenstrief Institute, Inc., Indiana University, Indianapolis, Indiana.
Division of General Internal Medicine and Geriatrics, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
The Research in Palliative and End of Life Communication and Training Center, Indiana University-Purdue University, Indianapolis, Indiana.
Daniel F. Evans Center for Spiritual and Religious Values in Health Care, Indiana University Health, Indianapolis, Indiana.
Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, Indiana.


The Protecting Access to Medicare Act of 2014 includes provisions for hospital readmission penalties for skilled nursing facilities (SNFs) starting in 2018. This presents an opportunity for care improvement but also raises several concerns regarding quality of care. The readmission measure for SNFs is similar to the current readmission measure for hospitals mandated under the Affordable Care Act, with the exception of adjustments made for sex. Because these measures for hospitals are similar, lessons can be learned from implementation of the existing hospital readmission penalties. In addition, there are three specific concerns that the authors relate to implementing the proposed measure in SNFs. There is poor communication and care coordination between care settings, including posthospitalization and post-SNF care in the current healthcare system. Adding readmission penalties to SNF regulations may create perverse incentives for prolonged SNF stays. The evidence base for the best means of caring for individuals after a brief stay in a SNF needs enrichment. These challenges need to be addressed as part of implementation of these new hospital readmission penalties for SNFs to improve care and prevent new unintended consequences.


care coordination; readmission penalty; rehospitalization penalty; skilled nursing facility; transitions of care

[Indexed for MEDLINE]

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