Leveraging Data to Improve Your 3-Day Rule Waiver Program

This post is Part Two of our coverage of the 3-day rule waiver and explains how to use data analytics to strengthen your 3-day rule waiver program. Part One shared strategies for building a program to manage this patient population.

Our first post on the 3-day rule waiver focused on considerations for building a program, including developing pathways for referral to skilled nursing facilities (SNFs), identifying SNF partners for the initiative, and creating a robust transitional care management program. In this post, we explain why data management is so critical to the success of any 3-day rule waiver program: the savings gained from shortening a patient’s initial hospital stay are quickly lost if the patient returns to the hospital a few days later for further treatment. To benefit from the 3-day rule waiver, health systems need to reduce the cost of care for an entire patient episode, as well as improve patient health outcomes. Read on to learn how to access and leverage data to drive continuous improvement to your program and ensure efficient management of your 3-day rule waiver patient population.

Gaining Access to (the Right) Data

While a hospital EMR can provide information on which 3-day rule waiver patients have been rehospitalized, this data alone is not sufficient to effectively evaluate the impact of a 3-day rule waiver program. Health systems need data on all post-acute activity, including the number of days patients spend in SNFs, which patient are rehospitalized at facilities outside of the system’s network, services patients are discharged with, and more.

In addition to spanning the care continuum, data must be timely. As soon as a trend develops, the health system needs to be made aware. If, for example, a third of the 3-day rule waiver patients referred to SNFs through the emergency department (ED) are returning to the hospital within 2 days, the health system needs to start investigating right away to reverse the trend.

To truly unlock the value of real-time data gathered across multiple care settings, health systems also need to designate a dedicated individual to manipulate the data, look for impacts, and identify areas for improvement. This individual should possess deep data analytics skills and experience, and ideally should work in conjunction with a program manager who can translate findings into actionable steps that improve outcomes for the health system’s 3-day rule waiver program.

What to Look for in the Data

Hospitals that we have worked with consistently identify these specific measures as most helpful in evaluating and refining their 3-day rule waiver programs:

Rehospitalization rate after implementing the 3-day rule waiver program

How does the rehospitalization rate for 3-day rule waiver patients compare to the rate for other ACO patients? To the general patient population? Pay particular attention to when patients are being rehospitalized. Rehospitalizations that occur within a short time period after hospital discharge can be an indication that the patient would have benefitted from additional inpatient days at the initial hospitalization.

SNF length of stay

How long are patients staying in SNFs after leaving the hospital? Reducing the number of days in the hospital might increase the number of days in the SNF, so it makes sense to evaluate whether your SNFs are finding they need to keep patients in the facility longer before they are ready for discharge. One strategy to reduce unnecessary SNF days is to use benchmarks to determine an appropriate SNF length of stay for a particular patient, then designate a staff member to work with the SNF as patients approach the benchmark. Community-based resources and in-home services, combined with a strong discharge plan, may allow the patient to be discharged safely from the SNF sooner.

Successful discharges

Compare SNF discharges to a similar cohort of non-3-day rule waiver patients to determine how a reduction in inpatient days impacts patient health outcomes. Ask and answer questions like these—

  • What percent of these SNF stays result in successful discharges to the community?
  • After a successful discharge from SNF, how many days did patients have in the community before they returned to the ED?
  • How many ED visits and hospitalizations did your 3-day rule waiver patients have in the 6 months following initial admission to SNF?

Break down the data for each of the three possible pathways to the SNF (from the hospital, the ED, and the community) to look for any impacts from the amount of acute care the patient received prior to the SNF stay.

Managing All the Moving Parts

Once a health system builds a 3-day rule waiver program, there are many factors that contribute to its efficacy, including staffing, SNF collaboration, data monitoring, and more. New technology tools like CarePort Insight and Connect are specifically designed to help health systems manage their programs, allowing patients to be identified and tracked, monitoring and comparing SNFs, and providing access to real-time data. Through careful planning and application of these tools, health systems can effect continuous, incremental improvements that bring them closer to meeting accountable care goals.

Learn more about how CarePort Connect and CarePort Insight can help you manage care across the continuum.