What Referral Partners Want to See Before They Send You Their Next Patient
Hospitals and health plans are narrowing their networks to the skilled nursing facilities they see as top performers. If you run a SNF, that means the review meeting with a referral partner increasingly decides who keeps getting inbound referrals.
The questions in the meetings are outcome-specific, and the SNFs that can answer them with their own data are in a much better position than the ones relying on a good relationship.
We've spent more than 8 years working with health systems and payers on transitions of care. We've sat on the other side of these conversations, which means we know what they ask for, how they score SNFs, and which gaps cost a building its next referral. Here is what referral partners want to see.
1. Who you admitted, and how complex they were
A hospital wants to know how many of its patients you admitted and what those patients needed. Acceptance rate and speed to accept alone doesn't tell the story. Decline reasons and admission timing give it context, because a decline for a clinical mismatch reads very differently than a slow response.
Response time is one of the first things hospitals measure, and they notice when it slips, but it’s certainly not where the measurement ends.
2. Where patients went after they left your building
Hospitals follow their patients past your front door. They want to see discharge destinations, how long the stay lasted, and what happened in the 30 days afterward.
That last window is where most SNFs lose sight of the patient. In a national study of Medicare patients, nearly 1 in 4 discharged home from a SNF were readmitted within 30 days, and the risk was highest in the first 2 days. A study of older adults in Indianapolis found that a home health visit within a week of SNF discharge was associated with a 39% lower risk of 30-day readmission.
So referral partners ask about outbound referrals, too. Did the home health agency accept the patient? How many days passed before the first visit? Did the agency send an update when the patient's condition changed?
3. Proof that you manage the handoff
Your discharge is someone else's admission. Referral partners want to see that you treat it that way, with the same attention a hospital gives its own transitions.
That means knowing which home health and hospice partners engage early, which ones follow through, and how you confirm care started. Families keep their choice of provider, and you still have a documented, managed handoff to point to.
4. Data they can compare
Referral partners already use your Five-Star rating, 30-day readmission rate, and average length of stay to compare you with the SNF down the road. Many also expect more from a preferred partner. In one study of ACOs with preferred SNF networks, 62% expected cost and quality data sharing and 53% expected automatic admission and discharge notification. Of those ACOs, 91% offered no financial incentive, so the currency is referral volume and data.
Good data comes with its definitions and its gaps. A partner trusts a SNF more when it explains how it measured something and what still needs work than when it hands over a polished number with no context.
5. Evidence of what you changed
The strongest meetings include what the team did differently. Staff ownership, earlier planning, clearer communication with partners, and how you resolve a missed handoff all show investment in the next leg of the patient's care. Ben Forrest, Olio's founder and CEO, puts the message this way: "we are investing in the next leg of these patients' care as your partner."
Why Olio knows this so well
Olio Transitions of Care Insights puts that data in your hands. It shows hospital-level reporting that follows each referring hospital's patients from admission and discharge through the receiving agency, the first visit, and any readmission. It also covers:
Admissions: referral volume by source and payer, accept and decline decisions with reasons, and response time.
Outcomes: discharge destinations, safe-return activity, and readmissions in the 30 days after discharge, by partner, building, and market.
Home health and hospice: agency acceptance, days from discharge to first visit, service refusals, and how responsive each agency is.
When you can walk into a hospital or health plan meeting with your own numbers, you give them a concrete reason to send you the next patient. That protects the referrals that drive your census, and it helps you earn more of them.
See it in Olio
If you want to see what your referral partners would see, we'd be glad to walk you through Olio Insights. You can learn more at olio.health/for-skilled-nursing-facilities.
