Archive for post-acute care

 

MedPAC Issues 2018 Report to Congress

The non-partisan legislative branch agency that advises Congress and the administration on Medicare payment policies has submitted its mandatory annual report to Congress.

Among the findings included in the report by the Medicare Payment Advisory Commission are:

  • Medicare’s hospital readmissions reduction program has not resulted in increases in emergency room visits or hospital observation stays.
  • Many Medicare accountable care organizations, while maintaining or improving quality, are producing more modest savings than predicted.
  • MedPAC approves of Medicare’s proposals to redesign the case-mix classification system for skilled nursing facilities.
  • MedPAC supports changes Medicare has proposed for patient assessment and therapy requirements for skilled nursing facilities.

MedPAC’s recommendations include:

  • Authorizing outpatient-only hospitals in isolated rural communities to ensure access to emergency care.
  • Reducing payments to off-campus emergency departments in certain urban areas.
  • Rebalancing Medicare’s physician fee schedule to increase payments for ambulatory evaluation and management services while reducing payments for procedures, imaging, and tests.
  • Paying for sequential stays in a unified prospective payment system for post-acute care.
  • Establishing new ways to help patients, families, and hospitals identify higher-quality post-acute care providers for their patients.
  • Establishing new principles for measuring quality that address both population-based measures and quality incentives.
  • Encouraging the development of managed

Nursing Homes Turning Away Addicted Patients

Nursing homes frequently refuse to serve patients being treated with medication to serve opioid addictions.

They do so even though opioid addiction is considered a chronic disease and recognized as such under the Americans With Disabilities Act.  While some nursing homes claim not to be aware of the obligation to serve such patients, others choose not to do so, with some claiming they lack the resources or expertise to serve such patients or that abstinence from opioid use is superior to medication as a treatment for opioid addiction.

As a result, many acute-care hospitals have difficulty finding skilled nursing placements for such patients who require post-acute care.

Learn more about why many nursing homes decline to admit patients being treated with medication for opioid addictions, the frequency of such refusals, and the legal and medical implications of their actions in this article from the Stat web site.…

MedPAC Mulls Uniform Outcome Measures to Complement Unified Post-Acute Payments

In support of its proposal that Medicare adopt a unified payment system for post-acute-care services, the Medicare Payment Advisory Commission is exploring how to develop uniform outcome measures to support such a new payment system.

Under the MedPAC vision, articulated at its early April public meeting, skilled nursing facilities, home health agencies, long-term-care hospitals, and inpatient rehabilitation facilities would see their outcomes quantified based on their performance on a series of quality measures.

Meanwhile, there has been little congressional interest in the unified post-acute payment proposal so far.  While some aspects of such a proposal could be implemented administratively, the comprehensive system would require legislation.

Learn more about the Medicare uniform outcomes measures proposal, the unified post-acute care payment proposal, how they interact, and the prospects for both from this article in Provider magazine.…

Socio-Economic Factors’ Role in Skilled Nursing Facility Finances

Skilled nursing facilities located in communities with higher-than-typical numbers of low-income and minority patients are under greater financial stress than comparable facilities located in other communities.

Nursing homes that serve higher proportions of Medicaid patients the same challenge.

And both of these conditions detract from the quality of care such facilities provide.

These are the findings of a new study published in the journal Health Services Research.

According to the study,

Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20-point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating.

 Learn more from the study “Geographic Disparities in Access to Nursing Home Services: Assessing Fiscal Stress and Quality of Care,” which appears in the Health Services Research.  Find a link to the study here.…

Little Rhyme or Reason to Post-Stroke Care Choices

Despite medical recommendations that stroke patients choose inpatient rehabilitation facilities for their post-acute care, significant numbers of patients continue to seek such care in skilled nursing facilities.

And experts do not understand why.

The choices, according to a new study, are based primarily on recommendations by hospitals and are being made despite a recommendation by the American Heart Association and American Stroke Association that patients turn to inpatient rehab facilities rather than skilled nursing facilities for post-stroke care.  Researchers found no apparent reason for the choices patients make between the two types of facilities.

Learn more about where stroke patients receive their post-discharge care and why they do so in the study Unexplained Variation for Hospitals’ Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke, which can be found here, on the web site of the journal Stroke.

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