RÉSUMÉ
Background Evidence suggests intracerebral hemorrhage survivors have earlier recovery compared with ischemic stroke survivors. The Centers for Medicare and Medicaid Services prospective payment system instituted documentation rules for inpatient rehabilitation facilities (IRFs) in 2010, with the goal of optimizing patient selection. We investigated whether these requirements limited IRF and increased skilled nursing facility (SNF) use compared with home discharge. Methods and Results Intracerebral hemorrhage discharges to IRF, SNF, or home were estimated using GWTG (Get With The Guidelines) Stroke registry data between January 1, 2008, and December 31, 2015 (n=265 444). Binary hierarchical models determined associations between the 2010 Rule and discharge setting; subgroup analyses evaluated age, geographic region, and hospital type. From January 1, 2008, to December 31, 2009, 45.5% of patients with intracerebral hemorrhage had home discharge, 22.2% went to SNF, and 32.3% went to IRF. After January 1, 2010, there was a 1.06% absolute increase in home discharge, a 0.46% increase in SNF, and a 1.52% decline in IRF. The adjusted odds of IRF versus home discharge decreased 3% after 2010 (adjusted odds ratio [aOR], 0.97; 95% CI, 0.95-1.00). Lower odds of IRF versus home discharge were observed in people aged <65 years (aOR, 0.92; 95% CI, 0.89-0.96), Western states (aOR, 0.89; 95% CI, 0.84-0.95), and nonteaching hospitals (aOR, 0.90; 95% CI, 0.86-0.95). Adjusted odds of SNF versus home discharge increased 14% after 2010 (aOR, 1.14; 95% CI, 1.11-1.18); there were significant associations in all age groups, the Northeast, the South, the Midwest, and teaching hospitals. Conclusions The Centers for Medicare and Medicaid Services 2010 IRF prospective payment system Rule resulted in fewer discharges to IRF and more discharges to SNF in patients with intracerebral hemorrhage. Health policy changes potentially affect access to intensive postacute rehabilitation.
Sujet(s)
Hémorragie cérébrale/rééducation et réadaptation , Réforme des soins de santé , Medicare (USA) , Évaluation des résultats et des processus en soins de santé/tendances , Sortie du patient/tendances , Système de paiements préétablis , Centres de rééducation et de réadaptation/tendances , Établissements de soins qualifiés/tendances , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Réforme des soins de santé/économie , Réforme des soins de santé/législation et jurisprudence , Accessibilité des services de santé/tendances , Humains , Patients hospitalisés , Mâle , Medicare (USA)/économie , Medicare (USA)/législation et jurisprudence , Adulte d'âge moyen , Évaluation des résultats et des processus en soins de santé/économie , Évaluation des résultats et des processus en soins de santé/législation et jurisprudence , Sortie du patient/économie , Sortie du patient/législation et jurisprudence , Processus politique , Système de paiements préétablis/économie , Système de paiements préétablis/législation et jurisprudence , Enregistrements , Centres de rééducation et de réadaptation/économie , Centres de rééducation et de réadaptation/législation et jurisprudence , Établissements de soins qualifiés/économie , Établissements de soins qualifiés/législation et jurisprudence , Facteurs temps , Résultat thérapeutique , États-UnisRÉSUMÉ
Rarely, if ever, does a national healthcare system experience such rapid and marked change as that seen with the COVID-19 pandemic. In March 2020, the president of the United States declared a national health emergency, enabling the Department of Health & Human Services authority to grant temporary regulatory waivers to facilitate efficient care delivery in a variety of healthcare settings. The statutory requirement that Medicare beneficiaries stay three consecutive inpatient midnights to qualify for post-acute skilled nursing facility coverage is one such waiver. This so-called Three Midnight Rule, dating back to the 1960s as part of the Social Security Act, is being scrutinized more than half a century later given the rise in observation hospital stays. Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule.
Sujet(s)
/organisation et administration , Infections à coronavirus/épidémiologie , Pneumopathie virale/épidémiologie , Établissements de soins qualifiés/législation et jurisprudence , Soins de suite/législation et jurisprudence , Betacoronavirus , COVID-19 , /législation et jurisprudence , Réforme des soins de santé , Humains , Medicare (USA)/législation et jurisprudence , Patients en consultation externe , Pandémies , SARS-CoV-2 , États-UnisRÉSUMÉ
In 2014, Oregon implemented an interfacility transfer communication law requiring notification of multidrug-resistant organism status on patient transfer. Based on 2015 and 2016 statewide facility surveys, compliance was 77% and 87% for hospitals, and 67% and 68% for skilled nursing facilities. Methods for complying with the rule were heterogeneous, and fewer than half of all facilities surveyed reported use of a standardized interfacility transfer communication form to assess a patient's multidrug-resistant organism status on transfer.
Sujet(s)
Bactéries/effets des médicaments et des substances chimiques , État de porteur sain , Clostridioides difficile/effets des médicaments et des substances chimiques , Multirésistance bactérienne aux médicaments , Transfert de patient/législation et jurisprudence , Établissements de soins qualifiés/législation et jurisprudence , Communication , Continuité des soins/législation et jurisprudence , Administrateurs d'établissement de santé , Hôpitaux/normes , Humains , Législation sur les hôpitaux , OrégonRÉSUMÉ
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUGIV) model, with a revised case-mix methodology called the Patient- Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary's SNF "resident" status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility Value-Based Purchasing (VBP) Program.
Sujet(s)
Medicare (USA)/économie , Système de paiements préétablis/économie , Établissements de soins qualifiés/économie , Achat basé sur la valeur/économie , Groupes homogènes de malades/économie , Groupes homogènes de malades/législation et jurisprudence , Humains , Medicare (USA)/législation et jurisprudence , Système de paiements préétablis/législation et jurisprudence , Indicateurs qualité santé/économie , Indicateurs qualité santé/législation et jurisprudence , Établissements de soins qualifiés/législation et jurisprudence , États-Unis , Achat basé sur la valeur/législation et jurisprudenceRÉSUMÉ
The Centers for Medicare and Medicaid Services (CMS) has scrutinized the provision of rehabilitation services in skilled nursing facilities (SNFs) for some time. Little research guidance exists on appropriate dosage or rehabilitation intensity (RI) among SNF patients or patients in other postacute care (PAC) settings. CMS developed a PAC assessment, the Continuity Assessment Record and Evaluation (CARE) Tool, in response to questions about what issues drive placement in various PAC settings under Medicare. The ability to adequately assess functional outcomes and correlate them to the RI provided by using the CARE Tool is promising. However, further research, policy advocacy, and practice analysis must be undertaken to promote and protect adequate access to occupational therapy and physical therapy in SNFs and other PAC settings. Individual practitioners must participate in data gathering to ensure that the data for analysis are fully informed by the occupational therapy perspective.
Sujet(s)
Référenciation , Politique de santé , Récupération fonctionnelle , Centres de rééducation et de réadaptation/normes , Établissements de soins qualifiés/normes , Humains , Medicare (USA) , Ergothérapie , Centres de rééducation et de réadaptation/législation et jurisprudence , Établissements de soins qualifiés/législation et jurisprudence , États-UnisRÉSUMÉ
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display. In addition, it finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare payment to SNFs beginning in FY 2019. The final rule also clarifies the regulatory requirements for team composition for surveys conducted for investigating a complaint and aligns regulatory provisions for investigation of complaints with the statutory requirements. The final rule also finalizes the performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020.
Sujet(s)
Medicare (USA)/économie , Medicare (USA)/législation et jurisprudence , Système de paiements préétablis/économie , Système de paiements préétablis/législation et jurisprudence , Établissements de soins qualifiés/économie , Établissements de soins qualifiés/législation et jurisprudence , Achat basé sur la valeur/économie , Achat basé sur la valeur/législation et jurisprudence , Humains , Vaccins antigrippaux , Assurance de la qualité des soins de santé/économie , Assurance de la qualité des soins de santé/législation et jurisprudence , États-UnisRÉSUMÉ
Accountable clinical processes aligned with EHR workflow can boost risk management efforts.
Sujet(s)
Dossiers médicaux électroniques/organisation et administration , Responsabilité légale , Gestion du risque/organisation et administration , Établissements de soins qualifiés/législation et jurisprudence , Humains , États-UnisSujet(s)
Medicare (USA)/normes , Bilan comparatif des médicaments/législation et jurisprudence , Qualité des soins de santé/législation et jurisprudence , Établissements de soins qualifiés/législation et jurisprudence , Soins de suite/législation et jurisprudence , Humains , Bilan comparatif des médicaments/économie , États-UnisRÉSUMÉ
The Protecting Access to Medicare Act of 2014 includes provisions for hospital readmission penalties for skilled nursing facilities (SNFs) starting in 2018. This presents an opportunity for care improvement but also raises several concerns regarding quality of care. The readmission measure for SNFs is similar to the current readmission measure for hospitals mandated under the Affordable Care Act, with the exception of adjustments made for sex. Because these measures for hospitals are similar, lessons can be learned from implementation of the existing hospital readmission penalties. In addition, there are three specific concerns that the authors relate to implementing the proposed measure in SNFs. There is poor communication and care coordination between care settings, including posthospitalization and post-SNF care in the current healthcare system. Adding readmission penalties to SNF regulations may create perverse incentives for prolonged SNF stays. The evidence base for the best means of caring for individuals after a brief stay in a SNF needs enrichment. These challenges need to be addressed as part of implementation of these new hospital readmission penalties for SNFs to improve care and prevent new unintended consequences.
Sujet(s)
Medicare (USA)/législation et jurisprudence , Réadmission du patient/économie , Remboursement incitatif/législation et jurisprudence , Établissements de soins qualifiés/législation et jurisprudence , Sujet âgé , Continuité des soins/législation et jurisprudence , Continuité des soins/normes , Femelle , Humains , Législation sur les hôpitaux , Mâle , Adulte d'âge moyen , Patient Protection and Affordable Care Act (USA)/législation et jurisprudence , Réadmission du patient/législation et jurisprudence , Établissements de soins qualifiés/normes , États-UnisRÉSUMÉ
INTRODUCTION: Currently, Medicare total joint arthroplasty patients are required to stay postoperatively 3 days in the hospital before discharge to a skilled nursing facility (SNF). We evaluated Medicare's mandated 3-night hospital stay rule to find out how many total joint arthroplastic patients are safe for discharge to SNFs on postoperative day 2 (POD2). METHODS: This is a retrospective case series analyzing Medicare primary total hip or total knee arthroplastic patients at a single hospital over 1 year. Patients meeting 15 separate criteria by POD2 were considered safe for discharge home rather than to a SNF. RESULTS: Of 259 patients, 47.88% met discharge criteria to SNF POD2. 31.66% did not meet 1, 13.13% did not meet 2, and 6.95% did not meet ≥3 criteria on POD2. Common criteria delaying discharge were blood pressure abnormalities, increasing or elevated white blood cell count, cardiac abnormalities, and fever. Thirty-day readmission rate for patients in the group safe for discharge POD2 was 1.75%. CONCLUSION: Of the total, 47.88% of patients required to stay by the Medicare 3-night stay rule were safe for discharge to SNF on POD2 without an increase in readmission rate at 30 days when compared to our institutional mean.
Sujet(s)
Arthroplastie prothétique de hanche/statistiques et données numériques , Arthroplastie prothétique de genou/statistiques et données numériques , Politique de santé/législation et jurisprudence , Hospitalisation/législation et jurisprudence , Durée du séjour/législation et jurisprudence , Medicare (USA)/législation et jurisprudence , Sujet âgé , Sujet âgé de 80 ans ou plus , Arthroplastie prothétique de hanche/législation et jurisprudence , Arthroplastie prothétique de hanche/normes , Arthroplastie prothétique de genou/législation et jurisprudence , Arthroplastie prothétique de genou/normes , Femelle , Politique de santé/économie , Hospitalisation/statistiques et données numériques , Humains , Durée du séjour/statistiques et données numériques , Mâle , Medicare (USA)/statistiques et données numériques , Adulte d'âge moyen , Sortie du patient/législation et jurisprudence , Sortie du patient/statistiques et données numériques , Période postopératoire , Études rétrospectives , Établissements de soins qualifiés/législation et jurisprudence , Établissements de soins qualifiés/statistiques et données numériques , Facteurs temps , États-UnisRÉSUMÉ
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2016. In addition, it specifies a SNF all-cause all-condition hospital readmission measure, as well as adopts that measure for a new SNF Value-Based Purchasing (VBP) Program, and includes a discussion of SNF VBP Program policies we are considering for future rulemaking to promote higher quality and more efficient health care for Medicare beneficiaries. Additionally, this final rule will implement a new quality reporting program for SNFs as specified in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). It also amends the requirements that a long-term care (LTC) facility must meet to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program, by establishing requirements that implement the provision in the Affordable Care Act regarding the submission of staffing information based on payroll data.
Sujet(s)
Medicare (USA)/économie , Système de paiements préétablis/économie , Indicateurs qualité santé/économie , Établissements de soins qualifiés/économie , Achat basé sur la valeur/économie , Collecte de données , Humains , Medicare (USA)/législation et jurisprudence , Affectation du personnel et organisation du temps de travail , Système de paiements préétablis/législation et jurisprudence , Amélioration de la qualité/économie , Amélioration de la qualité/législation et jurisprudence , Indicateurs qualité santé/législation et jurisprudence , Révision et fixation des tarifs/législation et jurisprudence , Établissements de soins qualifiés/législation et jurisprudence , États-Unis , Achat basé sur la valeur/législation et jurisprudenceRÉSUMÉ
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2015. In addition, it adopts the most recent Office of Management and Budget (OMB) statistical area delineations to identify a facility's urban or rural status for the purpose of determining which set of rate tables will apply to the facility, and to determine the SNF PPS wage index including a 1-year transition with a blended wage index for all providers for FY 2015. This final rule also contains a revision to policies related to the Change of Therapy (COT) Other Medicare Required Assessment (OMRA). This final rule includes a discussion of a provision related to the Affordable Care Act involving Civil Money Penalties. Finally, this final rule discusses the SNF therapy payment research currently underway within CMS, observed trends related to therapy utilization among SNF providers, and the agency's commitment to accelerating health information exchange in SNFs.
Sujet(s)
Medicare (USA)/économie , Système de paiements préétablis/législation et jurisprudence , Établissements de soins qualifiés/économie , Humains , Medicare (USA)/législation et jurisprudence , Établissements de soins qualifiés/législation et jurisprudence , États-UnisSujet(s)
Programmes de gestion intégrée des soins de santé/économie , Medicaid (USA)/économie , Medicare part C (USA)/économie , Établissements de soins qualifiés/économie , Services contractuels/économie , Services contractuels/législation et jurisprudence , Services contractuels/tendances , Humains , Programmes de gestion intégrée des soins de santé/législation et jurisprudence , Programmes de gestion intégrée des soins de santé/tendances , Medicaid (USA)/législation et jurisprudence , Medicaid (USA)/tendances , Medicare part C (USA)/législation et jurisprudence , Medicare part C (USA)/tendances , Patient Protection and Affordable Care Act (USA) , Établissements de soins qualifiés/législation et jurisprudence , Établissements de soins qualifiés/tendances , États-UnisSujet(s)
Emploi/législation et jurisprudence , Bourses de polices d'assurance-maladie/législation et jurisprudence , Personnel de santé/législation et jurisprudence , Patient Protection and Affordable Care Act (USA)/normes , Affectation du personnel et organisation du temps de travail/législation et jurisprudence , Coûts et analyse des coûts/législation et jurisprudence , Emploi/économie , Emploi/statistiques et données numériques , Bourses de polices d'assurance-maladie/économie , Bourses de polices d'assurance-maladie/statistiques et données numériques , Personnel de santé/économie , Personnel de santé/statistiques et données numériques , Mise en oeuvre des programmes de santé/économie , Mise en oeuvre des programmes de santé/législation et jurisprudence , Mise en oeuvre des programmes de santé/statistiques et données numériques , Humains , Soins de longue durée/économie , Soins de longue durée/législation et jurisprudence , Patient Protection and Affordable Care Act (USA)/économie , Affectation du personnel et organisation du temps de travail/économie , Affectation du personnel et organisation du temps de travail/statistiques et données numériques , Établissements de soins qualifiés/économie , Établissements de soins qualifiés/législation et jurisprudence , États-Unis , EffectifRÉSUMÉ
This final rule updates the payment rates used under the prospective payment system for skilled nursing facilities (SNFs) for fiscal year (FY) 2014. In addition, it revises and rebases the SNF market basket, revises and updates the labor related share, and makes certain technical and conforming revisions in the regulations text. This final rule also includes a policy for reporting the SNF market basket forecast error in certain limited circumstances and adds a new item to the Minimum Data Set (MDS), Version 3.0 for reporting the number of distinct therapy days. Finally, this final rule adopts a change to the diagnosis code used to determine which residents will receive the AIDS add-on payment, effective for services provided on or after the October 1, 2014 implementation date for conversion to ICD-10-CM.
Sujet(s)
Medicare (USA)/économie , Système de paiements préétablis/économie , Établissements de soins qualifiés/économie , Groupes homogènes de malades/économie , Groupes homogènes de malades/législation et jurisprudence , Humains , Medicare (USA)/législation et jurisprudence , Système de paiements préétablis/législation et jurisprudence , Établissements de soins qualifiés/législation et jurisprudence , États-UnisSujet(s)
Attitude envers la mort , Accompagnement de la fin de la vie/psychologie , Relations famille-professionnel de santé , Malades en phase terminale/psychologie , Documentation/normes , Services de soins à domicile/législation et jurisprudence , Services de soins à domicile/normes , Accompagnement de la fin de la vie/législation et jurisprudence , Accompagnement de la fin de la vie/normes , Établissements de soins palliatifs/législation et jurisprudence , Établissements de soins palliatifs/normes , Humains , Responsabilité légale , Relations entre professionnels de santé et patients , Établissements de soins qualifiés/législation et jurisprudence , Établissements de soins qualifiés/normes , États-UnisRÉSUMÉ
OBJECTIVE: To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. DATA SOURCES: Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. STUDY DESIGN: We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. DATA EXTRACTION METHODS: We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. PRINCIPAL FINDINGS: Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. CONCLUSIONS: Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms.
Sujet(s)
Réforme des soins de santé/économie , Réforme des soins de santé/législation et jurisprudence , Medicare (USA)/économie , Medicare (USA)/législation et jurisprudence , Patient Protection and Affordable Care Act (USA) , Système de paiements préétablis/économie , Système de paiements préétablis/législation et jurisprudence , Politique de santé , Organismes de prise en charge à domicile/économie , Organismes de prise en charge à domicile/législation et jurisprudence , Humains , Commission consultative indépendante MEDPAC (USA) , Centres de rééducation et de réadaptation/économie , Centres de rééducation et de réadaptation/législation et jurisprudence , Mécanismes de remboursement/économie , Mécanismes de remboursement/législation et jurisprudence , Établissements de soins qualifiés/économie , Établissements de soins qualifiés/législation et jurisprudence , Soins de suite/économie , États-UnisSujet(s)
Soins à domicile/économie , Soins à domicile/législation et jurisprudence , Medicare (USA)/économie , Medicare (USA)/législation et jurisprudence , Établissements de soins qualifiés/économie , Établissements de soins qualifiés/législation et jurisprudence , Sujet âgé , Soins ambulatoires/économie , Soins ambulatoires/législation et jurisprudence , Femelle , Humains , États-UnisRÉSUMÉ
As hospitals face growing pressure to reclassify inpatients to "observation" status, patients are the ones being hit with unexpected bills to pay what Medicare won't. One solution to the dilemma is a bill that would restructure the rules on when skilled-nursing care is paid for. "We have very broad-based support," says U.S. Rep. Joe Courtney (D-Conn.), left, one of the House sponsors.