Massachusetts Hospitals’ Discharge Trends Exceed Other States

Massachusetts has a higher rate of discharge from hospitals to other health care facilities relative to the national average, indicating an opportunity for better management of post-acute care, according to the state’s Health Policy Commission’s supplemental report released this month. The recent analysis is based on the state’s 2013 cost trends report.

Massachusetts hospitals are 2.1 times as likely as the national average to discharge patients to either nursing facilities or home health agencies, the researches estimate, noting that 98% of nursing facility beds in Massachusetts are dually certified for both short-term post acute care and long-term services and supports (LTSS).

Massachusetts spent $771, or 72%, more per resident than the U.S. average on long-term care and home health in 2009, the 2013 findings show.

While higher prices and an older age profile play a role in Massachusetts’ higher expenditures, the state’s use of home health care exceeds that of other states.

Based on data regarding hospital discharges in 2011, Massachusetts sent 74% more patients to home health care; 8% more patients to a skilled nursing facility (lSNF), intermediate care facility (ICF) or other type of facility; and 115% more to short-term hospital care than the national average. In 2011 the national average rate per 10,000 discharges was 1,088 to home health care, 1,389 to another type of facility and 213 to a short-term hospital. 

“There are also large utilization differences not accounted for by demographics,” the researchers say, adding that payment policies have been a significant driver of post-acute care utilization.

“The creation of the Medicare Inpatient Prospective Payment System in the 1980s encouraged hospitals to reduce length-of-stay in hospitals, leading to a shift in care from the inpatient setting to various post-acute care settings,” researchers say.

Pressures on facilities to shorten length of stay and increased penalties on hospitals with high readmission rates may also be contributing to the state’s increased use of post-acute care facilities.

Shifting care from institutional settings to home and community-based settings may increase more opportunities for home health care services and decrease total health care expenditure over time, researchers say, noting the higher cost of nursing facility care versus in home- and community-based care. 

The health department includes four recommendations of opportunity for the Massachusetts health system, including fostering a value-based market; promoting a high-quality health care delivery system, advancing alternative payment methods and enhancing data availability. 

The Commonwealth of Massachusetts Health Policy Commission will provide further analysis on those topics in early October.

“As provider organizations under global budgets seek to manage post-acute care more efficiently, trends in rates of discharge to nursing facilities and home health agencies, the choice of post-acute providers, and the average length-of-stay in post-acute care facilities will be important dimensions to observe,” researchers say. 

Read the state’s Health Policy Commission’s supplemental report here.  

Written by Cassandra Dowell