Post-Acute Care Transitions: Patient Experiences With the Medicare ACO Skilled Nursing Facility Three-Day Rule Waiver Program

Abstract

Objectives: To assess patient experiences with the Medicare ACO skilled nursing facility (SNF) three-day rule waiver program. Study Design: We developed and administered a survey to patients during their SNF stay to assess experience along five domains: patient-centered decision-making, satisfaction, readiness, care continuity, and communication. Methods: We assessed how patient responses differed based on acute care service, care program, and prior admission to SNF using logistic regression models. Results: Patients were generally satisfied with the care they received across the post-acute continuum. However, comparing patients that went to SNF after 1-3 overnights at the hospital to patients with no overnights who were discharged directly from the emergency department or observation units were significantly more likely to feel rushed in their medical decision making (OR = 3.88 [1.04-14.4]) and less likely to feel satisfied with how their medical team prepared them for their transition (OR = 0.16 [0.03-0.94]). Patients in a specialized care management program were significantly more likely to feel satisfied with how their medical team prepared them for their transition (OR = 7.83 [1.66-37.0]). Conclusions: While the SNF three-day rule waiver is designed to expedite the transition from hospital to SNF where appropriate, patients discharged directly to a SNF without an inpatient hospital stay reported feeling more rushed and less prepared, highlighting the need for improvements geared towards this subpopulation. More positive experiences among patients in a care management program suggest that increasing communication, care coordination and follow-up may help achieve these improvements.