Unbiased Analysis of Today's Healthcare Issues
An interesting article by Mor (2023) examines the history of the requirement for a 3-day hospital stay for Medicare to cover a skilled nursing facility (SNF) transfer. The 3-day requirement: …was introduced very early in the history of the Medicare SNF benefit at a time when most nursing homes (NHs) offered primarily custodial care and…
Value-based purchasing is supposed to tie reimbursement to quality of care and costs. Providers that are high quality and low cost are supposed to get higher reimbursement, those that are low quality and high cost the reverse. The key question is: does this reimbursement approach work in practice? According to a recent study by Grabowski…
Why don’t payers adopt innovative approaches to treat mental illness? For instance, crisis intervention programs, recovery-focused consumer education programs, telehealth programs, and on-line treatment programs have sometimes have had problems receiving reimbursement from payers. Monica Oss of OpenMinds takes the payers’ perspective: Often, the organization proposing the new program comes to the table with an…
In the past, I have written about how Medicare pays for Skilled Nursing Facilities (SNF). Medicare uses a case-mix adjusted per diem rate. This approach, however, isn’t the only manner payers can use to reimburse nursing facilities. Consider how Australia pays for nursing care under their Australian National Sub-Acute and Non-Acute Patient Classification System (AN-SNAP):…
The Office of the Inspector General found substandard care at a number of skilled nursing facilities. Their investigation found the following: For 37 percent of stays, SNFs did not develop care plans that met requirements or did not provide services in accordance with care plans. For 31 percent of stays, SNFs did not meet discharge…
Although many people believe that the U.S. healthcare system is a free-market, that is far from the case. Consider nursing homes. Two-thirds of patient spending on nursing home care comes from public sources. Not only do public funds pay for the variable cost of running nursing homes, but the federal government also provides low-interest…
Medicare spends a lot of money on beneficiaries living in nursing homes. How expensive are these beneficiaries: Six percent of Medicare beneficiaries spend some time in a long-term care facility, but these same beneficiaries make up 17% of total Medicare cost. Three percent of Medicare beneficiaries spent an entire year in a long-term care facilities.…
Under Medicare Part A, beneficiaries can receive coverage for care provided by skilled nursing facilities (SNFs), also known as nursing homes. Between 2000 and 2007, however, the rate of potentially avoidable re-hospitalizations for five key conditions (congestive heart failure, respiratory infection, urinary tract infection, sepsis, and electrolyte imbalance) increased from 13.7% to 18.5%. One potential explanation…