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Medicare Links Nursing Home Payments To Quality Of Care: Shots

Medicare's new program will change a year's worth of payments to 14,959 skilled nursing facilities across the U.S., based on…

Medicare’s new program will change a year’s worth of payments to 14,959 skilled nursing facilities across the U.S., based on how often in the past fiscal year their residents ended up back in hospitals within 30 days of leaving.

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Medicare’s new program will change a year’s worth of payments to 14,959 skilled nursing facilities across the US, based on how often in the past fiscal year their residents ended up in hospitals within 30 days of leaving.

BSIP / Getty Images

The federal government took a new step this week to reduce avoidable hospital readmissions of nursing home patients. The move targets the homes’ bottom line by lowering a year’s worth of payments to nearly 11,000 nursing homes, and giving bonuses to almost 4,000 others.

These financial incentives, determined by each home’s readmission rates, significantly expand Medicare’s effort to pay medical

Until now, Medicare limited these types of incentives mostly to hospitals, which have been used to face financial repercussions if too many of their patients are readmitted , suffer infections or other injuries or those.

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

The new Medicare program is changing a year’s worth of payments to 14,959 skilled nursing facilities, based on how often their residents Ended up in hospitals within 30 days of leaving.

Hospitalizations of nursing home residents, while decreasing in recent years, remain a problem: Nearly 11 percent of patients in 2016 were sent to hospitals for conditions that might have been averted with better medical supervision.

These bonuses and penalties are also intended to discourage nursing homes from discharging patients too quickly – something that is financially tempting as Medicare fully covers only the first 20 days of a stay and generally stops paying anything after 100 days. 19659015] About this fiscal year, which began Oct. 1 en gaat door het einde van september 2019 zullen de best-presterende woningen 1,6 procent meer ontvangen voor elke medicare dan zij zouden hebben anders. De worst-performing homes zullen bijna 2 procent van elke betaling verliezen. The others will fall in between.

For-profit nursing homes, which make up two-thirds of the nation’s facilities, face deeper cuts on average than do nonprofit and government-owned homes, A Kaiser Health News analysis of the data found.

In Arkansas, Louisiana and Mississippi, 85 percent of homes will lose money, the analysis found. More than half in Alaska, Hawaii and Washington state will get bonuses.

Overall, 10,976 nursing homes will be penalized, 3,983 will get bonuses and the rest will not experience any change in payment, the KHN analysis found.

Medicare is reducing payments to 12 of the 15 nursing homes run by Otterbein SeniorLife, an Ohio faith-based nonprofit. Pamela Richmond, Otterbein’s chief strategy officer, says most of his readmissions occurred with patients after they went home, not while they were in the nursing facilities. Otterbein anticipates losing $ 99,000 over the year.

“We’re super disappointed,” Richmond says about the penalties. Hun forteller Otterbein har startet med å følge med tidligere patienter, eller med hjemmebaserede organer som sender sygeplejersker og aides til patienters hus til omsorg for dem. If there are signs of trouble, Otterbein will try to arrange care or bring patients back to the nursing home if necessary.

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

Congress created the Skilled Nursing Facility Value-Based Purchasing Program incentives in the 2014 Protecting Access to Medicare Act. In de toekenning van bonussen en boetes heeft Medicare beoordeeld elke faciliteit op twee manieren: hoe het ziekenhuistarief in kalenderjaar 2017 vergeleken met andere faciliteiten en hoe veel die tarieven zijn veranderd van kalenderjaar 2015.

Faciliteiten ontvangen scores van 0 tot 100 voor hun performances and 0 to 90 for their improvements; De højere av de to scorer blev brugt til at bestemme deres samlede score. Facilities were then ranked highest to lowest.

Medicare is not measuring readmission rates of patients who are insured through private Medicare Advantage plans, even though in some regions the majority of Medicare beneficiaries rely on those to afford their care.

Through The incentives, Medicare will redistribute $ 316 million from poorer-performing to better-performing nursing homes. Medicare expects it will keep another $ 211 million that it would have otherwise paid to nursing homes if the program did not exist.

The new payments augmented other pressures nursing homes face from Medicare and State Medicaid programs to lower readmissions to hospitals. [19659008] “Skilled facilities have been working towards this and knew it was coming,” says Nicole Fallon, vice president of health policy and integrated services at LeadingAge, an association of nonprofit providers of services for seniors.

The American Health Care Association, a trade group of nursing homes, reports in a written statement that it has supported the program and is pleased to see that more than a quarter of facilities received bonuses.

While most researchers believe that readmissions can be reduced, some consumer advocates fear That nursing homes will be reluctant to admit very infirm residents or to re-hospitalize patients when they need medical care.

“It may end up forårsaker stor smerte til beboere som faktisk trenger å bli hospitalized, “siger Patricia McGinnis, administrerende direktør for California Advokater for Nursing Home Reform, som er baseret i San Francisco.

Fallon sier Medicare kan endelig straffe hjem som har gjort alt de kan To prevent return trips to the hospital. But because of the program’s design at Congress, Medicare still needs to punish large numbers of homes.

“Fallon says,” There are always going to be winners and losers. ” “At what point have we achieved all we can achieve?”

Meanwhile, Medicare is looking to expand financial incentives to other types of providers. Sedert 2016, heeft het been getest van kwaliteitsbonussen en sancties voor thuisgezondheidsbureaus in negen staten. Richmond, the nursing home executive, applauded that kind of expansion.

“There are a whole bunch of people in this chain” or institutions caring for patients at different stages, she says, “and we all need to be working in a common direction. “

Kaiser Health News a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanent. KHN data editor Elizabeth Lucas contributed to this report.

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