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Medicare left nursing home payments to the quality of care: shots



Medicare's new program will change one year's payments to 14,959 qualified care facilities in the United States, depending on how many times their residents returned to hospitals within 30 days of their departure.

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Medicare's new program will change one-year payments to 14,959 nursing homes in the US, based on how many times their residents have landed in hospitals within 30 days of their release.

BSIP / Getty Images

The Federal Government has taken a new step this week to reduce preventable hospitalization of nursing home patients. The move aims to reduce the final housing yield by reducing one year's payments to nearly 11,000 nursing homes and granting nearly 4,000 other premiums.

These financial incentives, which are determined by each house's readmission rates, increase Medicare's efforts to pay medical care providers are based on the quality of care, not just the number or condition of their patients.

To date, Medicare has limited these incentives mainly to hospitals that have become accustomed to the financial impact of resuming too many of their patients, suffering infection or other injury, or dying.

"For some nursing homes, this could mean a significant amount of money," says Thomas Martin, director of post-acute analytics at CarePort Health, who works in both hospitals and nursing homes. "Many work with very low margins."

The new Medicare program will change one year's payments into 14,959 qualified care facilities, depending on how many times their residents have resettled in hospitals within 30 days of discharge.

Hospitalization of nursing home residents has declined in recent years, but remains a problem: Nearly eleven percent of patients were sent to hospitals in 2016 because conditions may have been better

These bonuses and penalties should also discourage nursing homes Delay patients too quickly – something that is financially attractive, since Medicare only fully covers the first 20 days of a stay and usually pays for it after 100 days. 19659015] In this fiscal year, which began on October 1 and continues through the end of September 2019, the most powerful houses receive 1.6 percent more for the Medicare patient than they would otherwise have. The worst performing houses lose almost two percent of every payment. The others will fall in between. (You can check the results for the individual care facilities in your area here.)

For-profit nursing homes, which make up two-thirds of the nation's institutions, are on average more in-depth cuts than non-profit and state-owned houses. An analysis of data from Kaiser Health News.

In Arkansas, Louisiana and Mississippi, 85 percent of homes will lose money, according to the analysis. Over half in Alaska, Hawaii and the US state of Washington will receive bonuses.

A total of 10,976 nursing homes will be punished, 3,983 bonuses and the remainder will experience no payment changes, according to the KHN analysis.

Medicare reduces payments to 12 out of the 15 nursing homes of Otterbein SeniorLife, a Ohio-based charitable organization. Pamela Richmond, Otterbein's Chief Strategic Officer, says most of the readmissions were in patients after they went home, not while they were in the care facilities. Otterbein expects to lose $ 99,000 during the year.

"We are very disappointed," Richmond says of the penalties. She says Otterbein has started contacting former patients, or from the health authorities, who send nurses and helpers to the patients' homes to look after them. If there are signs of problems, Otterbein will try to arrange the treatment or, if necessary, bring patients back to the nursing home.

"It really sets the focus on us. After leaving the city, better care should be provided," says Richmond.

Congress has created incentives for the value-based purchasing program for skilled care facilities as part of the 2014 Plan to Protect Access to Medicare Law. In allocating premiums and penalties, Medicare assessed the performance of each institution in two ways: How did hospitalization rates compare with other institutions in calendar year 2017, and how much did they change in comparison to calendar year 2015?

The facilities were rated 0 to 100 for their facilities and 0 to 90 for their improvements; The higher of the two points was used to determine the overall score. The facilities were then rated from the highest to the lowest ranks.

Medicare does not measure the readmission rates of patients insured under Medicare Advantage private plans, even though the majority of Medicare beneficiaries in some regions depend on the caregiver to afford them.

Through Incentives, Medicare will redistribute $ 316 million from underperforming care homes to higher performing care homes. Medicare expects it to withhold another $ 211 million that would otherwise have been paid for nursing homes if the program did not exist.

The new payments increase the pressure on other nursing homes that emanate from Medicare and Medicaid state programs to reduce hospital readmission. [19659008] "Qualified institutions have worked to that end and knew it would come," says Nicole Fallon, Vice President of Health Policy and Integrated Services at LeadingAge, a consortium of non-profit providers of senior services.

A trade group of nursing homes reported in a written statement that they had supported the program and were pleased that more than a quarter of the facilities had received premiums.

While most researchers believe that readmission can be reduced, some consumers fear fears that nursing homes will be reluctant to accommodate very weak residents or bring patients back to hospital, even if they need medical care.

"It may end up resident who actually need to be hospitalized are very painful," says Patricia McGinnis, Executive Director of California Advocates For Nursing Home Reform, San Francisco.

Fallon says Medicare may punish houses that have done everything they can to prevent return flights to the hospital. But due to the program designed by Congress, Medicare still has to punish a large number of houses.

"There will always be winners and losers, even if you make good progress," says Fallon. "At what point in time have we achieved everything we can achieve?"

Meanwhile Medicare wants to extend the financial incentives to other providers. Since 2016, quality bonuses and penalties for home health departments have been tested in nine states. Richmond, the nursing home executive, welcomed this type of expansion.

"There are quite a few people in this chain" of institutions looking after patients at different stages, "she says," and we all have to work together in a hospital ward.

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


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