Archive for Medicare post-acute care


Low-Income Patients More Likely to End Up in Low-Quality SNFs

Dually eligible individuals are more likely than others to find themselves in low-rated skilled nursing facilities, recent research has found.

According to a study published in the Journal of Applied Gerontology, more than 50 percent of dually eligible individuals – those covered by both Medicare and Medicaid – who are admitted to skilled nursing facilities are served by facilities that have low (one or two stars) ratings under Medicare’s five-star quality rating system for nursing homes.  Overall, the dually eligible are 9.7 percentage points more likely than patients not on Medicaid to be served by lower-rated facilities.

The education of those individuals and their distance from higher-quality facilities are the two leading reasons.  According to the study, lower-quality skilled nursing facilities are more likely to be located in or near low-income communities.  Health status and race also are contributing factors.

Learn more in the Journal of Applied Gerontology article “Medicaid and Nursing Home Choice:  Why Do Duals End Up in Low-Quality Facilities?” and from the McKnight’s Long-Term Care News report “More than 50% of dual-eligibles end up in low-rated SNFs, study finds.”


Feds Looking to Bundle Medicare Post-Acute Payments?

Bring us your ideas for bundling Medicare post-acute-care payments, the head of the Center for Medicare and Medicaid Innovation recently told a gathering of hospital officials in Washington, D.C.

As reported by Fierce Healthcare, CMMI director Adam Boehler told hospital officials that

Now is the time to bring us ideas.  We’re really in listening mode…I think there’s been a lot of intrigue and interest we’ve heard from people.  So we’re gathering stakeholder input there on that and it’s a great time to give us thoughts on where we can lower costs.

Learn more from the Fierce Healthcare article “CMMI’s Adam Boehler: ‘Now is the time’ to bring post-acute care bundle ideas.”

SNF Discharge May Affect Hospital Readmission Rates

Heart failure patients discharged from skilled nursing facilities after two days or less may be as much as four times more likely to be readmitted to a hospital than those who stay longer, according to a new analysis.

The study also found that the hospital readmission rate falls by half for patients who remain in a skilled nursing facility for one to two weeks.

The analysis evaluated Medicare data for heart failure patients at least 65 years old and did not adjust for their severity of illness.

These findings suggest that the current emphasis on limiting patients’ time in post-acute-care settings may not contribute to their return to good health and increases their chances of being readmitted to a hospital.  Even under ideal circumstances, 25 percent of heart failure patients admitted to skilled nursing facilities are readmitted to a hospital within 30 days of discharge.

Learn more from the Healthcare Finance News article “Shorter stays in a skilled nursing facility tied to higher risk for readmission” and the Journal of Post-Acute and Long-Term Care Medicine study “Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study.”

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s April agenda were:

  • Expanding the use of value-based payment in Medicare
  • Medicare Shared Savings Program performance
  • Redesigning the Medicare Advantage quality bonus program
  • Increasing the accuracy and completeness of Medicare Advantage encounter data
  • Evaluating patient functional assessment data reported by post-acute-care providers
  • Options for slowing the growth of Medicare fee-for-service spending for emergency department services
  • Options to increase the affordability of specialty drugs and biologics in Medicare Part D
  • Improving payment for low-volume and isolated outpatient dialysis facilities

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.


Mixed Verdict: Home Health Leads to More Readmissions But Lower Costs

Readmission rates are greater for patients discharged from hospitals to home health care than they are for those discharged to skilled nursing facilities but home health services cost so much less than nursing homes that home health saves money even with the higher numbers of hospital readmissions.

This is one of the major findings of a new study comparing differences in outcomes for patients who are admitted to skilled nursing facilities upon discharge from the hospital to those for patients who go direct home and receive home health services.

The study also found no meaningful differences in patient mortality or functional outcomes.

Readmissions from home health are 5.6 percent greater than those from skilled nursing facilities but with the much lower cost of home health services, Medicare saves, on average, more than $5400 over the first 60 days after discharge when patients are discharged to home health services rather than nursing homes.

Hospitals, it appears, prefer to discharge patients to nursing homes – perhaps, the study’s authors suggest, because of concern for their own readmission rates, which are subject to review and penalty under Medicare’s hospital readmissions reduction program.  Also, relatively few hospitals participate in alternative payment models that encompass …