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Medicare Cuts Payments To Nursing Homes Whose Patients Keep Ending Up In Hospital

Jordan Rau, Kaiser Health News

The federal authorities has taken a brand new step to scale back avoidable hospital readmissions of nursing dwelling sufferers by decreasing a 12 months’s price of funds to almost 11,000 nursing properties. It gave bonuses to almost four,000 others.

These monetary incentives, decided by every dwelling’s readmission charges, considerably increase Medicare’s effort to pay medical suppliers primarily based on the standard of care as a substitute of simply the quantity or situation of their sufferers. Until now, Medicare restricted these sorts of incentives largely to hospitals, which have gotten used to going through monetary repercussions if too lots of their sufferers are readmitted, endure infections or different accidents, or die.

“To some nursing homes, it could mean a significant amount of money,” mentioned Thomas Martin, director of post-acute care analytics at CarePort Health, which works for each hospitals and nursing properties. “A lot are operating on very small margins.”

The new Medicare program is altering a 12 months’s price of funds to 14,959 expert nursing services primarily based on how usually their residents ended up again in hospitals inside 30 days of leaving. Hospitalizations of nursing dwelling residents, whereas reducing in recent times, stay an issue, with practically 11 percent of patients in 2016 being despatched to hospitals for situations that may have been averted with higher medical oversight.

These bonuses and penalties are additionally meant to discourage nursing properties from discharging sufferers too rapidly — one thing that’s financially tempting as Medicare absolutely covers solely the primary 20 days of a keep and customarily stops paying something after 100 days.

Over this fiscal 12 months, which started Oct. 1 and goes via the top of September 2019, the best-performing properties will obtain 1.6 % extra for every Medicare affected person than they might have in any other case. The worst-performing properties will lose practically 2 % of every cost. The others will fall in between. (You can see the scores for particular person nursing services here.)

For-profit nursing properties, which make up two-thirds of the nation’s services, face deeper cuts on common than do nonprofit and government-owned properties, a Kaiser Health News evaluation of the data discovered.

In Arkansas, Louisiana and Mississippi, 85 % of properties will lose cash, the evaluation discovered. More than half in Alaska, Hawaii and Washington state will get bonuses.

Overall, 10,976 nursing properties shall be penalized, three,983 will get bonuses, and the rest won’t expertise any change in cost, the KHN evaluation discovered.

(Story continues beneath.)

Medicare is decreasing funds to 12 of the 15 nursing properties run by Otterbein SeniorLife, an Ohio faith-based nonprofit. Pamela Richmond, Otterbein’s chief technique officer, mentioned most of its readmissions occurred with sufferers after they went dwelling, not whereas they had been within the services. Otterbein anticipates dropping $99,000 over the 12 months.

“We’re super disappointed,” Richmond mentioned in regards to the penalties. She mentioned Otterbein is beginning to observe up with former sufferers or the house well being companies that ship nurses and aides to their homes to look after them. If there are indicators of hassle, Otterbein will attempt to organize care or carry sufferers again to the nursing dwelling if needed.

“This really puts the emphasis on us to go out and coordinate better care after they leave,” Richmond mentioned.

Congress created the Skilled Nursing Facility Value-Based Purchasing Program incentives within the 2014 Protecting Access to Medicare Act. In assigning bonuses and penalties, Medicare judged every facility’s performances in two methods: how its hospitalization charges in calendar 12 months 2017 in contrast with different services and the way a lot these charges modified from calendar 12 months 2015.

Facilities obtained scores of zero to 100 for his or her performances and zero to 90 for his or her enhancements, and the upper of the 2 scores was used to find out their general rating. Facilities had been then ranked highest to lowest.

Medicare isn’t measuring readmission charges of sufferers who’re insured via non-public Medicare Advantage plans, although in some areas the vast majority of Medicare beneficiaries depend on these to afford their care.

Through the incentives, Medicare will redistribute $316 million from poorer-performing to better-performing nursing properties. Medicare expects it’s going to preserve one other $211 million that it could have in any other case paid to nursing properties if this system didn’t exist.

The new funds increase different pressures nursing properties face from Medicare and state Medicaid packages to decrease readmissions to hospitals.

“Skilled facilities have been working toward this and knew it was coming,” mentioned Nicole Fallon, vp of well being coverage and built-in companies at LeadingAge, an affiliation of nonprofit suppliers of growing old companies.

The American Health Care Association, a commerce group of nursing properties, mentioned in an announcement that it had supported this system and was gratified to see that greater than 1 / 4 of services obtained bonuses.

While most researchers imagine that readmissions could be lowered, some client advocates worry that nursing properties shall be reluctant to admit very infirm residents or to re-hospitalize sufferers even after they want medical care.

“It may end up causing great pain to residents who actually need to be hospitalized,” mentioned Patricia McGinnis, govt director of California Advocates for Nursing Home Reform, which is predicated in San Francisco.

Fallon mentioned Medicare ultimately might penalize properties which have finished all they’ll to stop return journeys to the hospital. But due to this system’s design by Congress, Medicare nonetheless might want to punish giant numbers of properties.

“There’s always going to be winners and losers, even if you make good progress,” Fallon mentioned. “At what point have we achieved all we can achieve?”

Meanwhile, Medicare is seeking to increase monetary incentives to different kinds of suppliers. Since 2016, it has been testing high quality bonuses and penalties for dwelling well being companies in 9 states. Richmond, the nursing dwelling govt, applauded that form of enlargement.

‘There’s a complete bunch of individuals on this chain” of establishments caring for sufferers at totally different phases, she mentioned, “and we all need to be working in a common direction.”

KHN information editor Elizabeth Lucas contributed to this report.

KHN’s protection associated to growing old and enhancing care of older adults is supported partly by The John A. Hartford Foundation.

Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially impartial program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.

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