Scott Regenbogen

Scott Regenbogen, M.D. is a colorectal surgeon and Co-Director of MVC

In last week’s blog, Edward Norton discussed the relationship between the Centers for Medicare and Medicaid Services’ (CMS) Hospital Compare “star ratings” and other measures of short-term outcome after major cancer surgery. He suggested that “the star rating may be useful to patients when they are selecting a hospital for major cancer surgery”. To date, however, there is little evidence that patients really take these ratings into account when choosing a hospital.

What about post-acute care choices, though? We’ve talked before in the Michigan Value Collaborative (and in the MVC blog) about the critical role of post-acute care choices in episode spending, especially for surgical conditions. To date, we’ve looked at it primarily from the hospitals’ and payers’ perspectives, but it is actually the patient and family who ultimately choose their site of care after hospitalization.

To help with these decisions, there are a variety of information sources that patients and families—the consumer of post-acute care—could use. For example, CMS Nursing Home Compare provides information on numerous measures of nursing home quality, and has a “star rating” system, much like the Hospital Compare website. Unfortunately, consumers rarely make use of these resources in their decision-making about care after hospitalization.

A recent paper in the Journal of the American Geriatrics Society  interviewed nearly 100 community-dwelling patients newly admitted to skilled nursing facilities (SNF) in eight US cities after acute hospitalization, and inquired about their roles in, and the process of, SNF choice. In general, the patients reported negative experiences with the decision-making process—they felt they were rushed, provided with inadequate information about quality and capabilities of the facilities, and that their physicians were not involved in the decision. They generally stated that their decisions were based on previous experiences with facilities, location, or amenities, but that they would have availed themselves of information about care quality if it had been readily available. Further, most would have been willing to travel further in order to be admitted to a higher-rated facility.

We need better sources of information to aid patients in choosing post-acute care providers. At the moment, some are using Facebook or other online networks to receive information about facilities, but the ratings seen in these sites often disagree with more scientifically validated quality metrics. Tailored information sources that provide information more suited to individuals’ particular preferences and needs could substantially improve the usefulness of recommendations.

For MVC, we need to consider this information gap as we work to optimize the use of post-acute care. Many of our members are focused on appropriate, and better informed, choice of SNF for their patients as a strategy to control episode spending. And as a Coordinating Center, we are increasingly focused on efforts to reduce the potentially unnecessary use of inpatient post-acute care after major joint replacement and other procedures. To achieve these goals, however, we will need to attend to the decision-making needs of the patients and families, in addition to our hospital leaders and policy-makers.