elderly help walking with balance disorder Rehospitalization

The Importance of Low-Rehospitalization Rates in Post-Acute Care

As of 2017, there have been two federal laws that require providers to publicly report their 30-day rehospitalization rates. The first piece of legislation is the Protecting Access to Medicare Act of 2014, which created the skilled nursing facility value-based purchasing program. The program pays nursing facilities based on how well they meet clinical performance criteria. The other law is the Improving Medicare Post-Acute Care Transformation Act of 2014. This piece of legislation requires nursing facilities, long-term care hospitals, home health agencies, and rehabilitation facilities to collect and submit clinical performance data to Medicare.

The laws are meant to ensure healthcare institutions are transparent in their operations, and they are providing quality care to patients. If their rates are too high, the healthcare provider will be faced with a penalty of up to 2% of their Medicare payments. 

How Post-Acute Care Facilities Maintain Low Rehospitalization 

In order for post-acute care facilities to keep rehospitalization rates low, they must maintain a high standard of care. There are several ways they achieve this, such as patient assessments, care planning, early intervention, coordination, and staff competencies. 

Patient Assessment

More than ever, hospitals are discharging patients to post-acute facilities for continued support for their medical needs. As a result, patient assessments are a crucial first step in providing an effective plan of action. This includes studying the patient’s medical records and talking with them about their condition during intake. 

Care Planning

Once an assessment has been made, a care plan will be developed to outline the patient’s overall treatment. It will address goals for the patient and the clinical risk factors that, if left unintended, may send them back to the hospital. 

Early Intervention

To provide efficient care for their patients, post-acute staff must be able to identify changes in their patient’s condition as soon as possible. In doing so, they can lessen the chance of their ailment getting worse. 


Post-acute facilities that coordinate with hospitals that discharge patients are likely to have a better chance of obtaining low readmission rates. One area that post-acute providers may focus on is utilizing effective communication tools. By implementing effective communication technologies, facilities can connect with each other to share information regarding patients’ medications and other treatments being administered before they are admitted. 

Staff Capabilities

It’s no surprise that the skills and capabilities of the post-acute staff are important in the success of a facility. Care providers must hire, train, educate, and develop employees to meet the needs of their patients. This could include writing and executing care plans, diagnostic skills, assessing health status and readmission risk of patients, and the ability to use personal and digital tools to better coordinate with patients and other health facilities. 

How South Coast Post Acute Can Help

A successful post-acute facility begins with a high level of care. At South Coast Post Acute we are committed to providing excellent services for our clients to ensure an effective recovery with a low chance of rehospitalization. We are passionately dedicated to providing the quality of service and care you come to expect from Southern California’s leading post-acute care provider. Through our innovative care and dedicated, experienced staff, we strive to provide the best patient care with a focus on reducing your length of stay when possible and preventing 30-day rehospitalizations. Contact us today to learn how we can help you on your journey back to full health. 

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