Archive for Medicare post-acute care


MedPAC Issues Annual Report to Congress

The Medicare Payment Advisory Commission has sent its mandatory annual report to Congress.

Included in the report are sections on:

  • Beneficiary enrollment in Medicare: eligibility notification, enrollment process, and Part B late enrollment penalties.
  • Restructuring Medicare Part D for the era of specialty drugs.
  • Medicare payment strategies to improve price competition and value for Part B drugs.
  • MedPAC’s mandated report to Congress on clinician payments.
  • Issues in Medicare beneficiaries’ access to primary care.
  • Assessment of the Medicare Shared Savings Program’s effect on Medicare spending.
  • Ensuring the accuracy and completeness of Medicare Advantage encounter data.
  • Redesigning the Medicare Advantage quality bonus program.
  • Payment issues in post-acute care.
  • MedPAC’s mandated report to Congress on changes in post-acute and hospice care after implementation of the long-term care hospital dual payment rate structure.
  • Options for slowing the growth of Medicare fee-for-service spending for emergency department services.
  • Promoting integration in dual-eligible special needs plans.

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.

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Some Readmissions From Nursing Homes to Hospitals Hard to Avoid

Improvements in the delivery of care cannot prevent some skilled nursing facility patients from being readmitted to hospitals, a new study has concluded.

According to the study, when advanced practice nurses brought best practices to 16 nursing homes participating in a Medicare pilot program, they enjoyed considerable success reducing hospital readmissions but found themselves unable to stop some, including readmissions caused by residents or their families calling ambulances on their own; patients refusing treatment and then demanding hospitalization because of the effects of the denied treatment; and patients in hospice deciding they want surgery.

These were among the findings in a study to be published next month in the Journal of Nursing Care Quality.  For preview, see the McKnight’s Long-Term Care News article “Researchers: More hospital admissions are ‘unavoidable’ than previously thought.”


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.”