CMS proposes payment changes for skilled nursing facilities

The Centers for Medicare & Medicaid Services (CMS) has introduced a new program that would provide skilled nursing facilities (SNFs) with extra payments in order to help prevent their patients from being admitted and readmitted to acute care hospitals.

The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents would pay physicians at SNFs the same to conduct a comprehensive patient assessment at the facilities as it would if the exam was performed in an inpatient hospital. SNFs could use the additional revenue to purchase equipment that could improve intravenous therapy and cardiac monitoring--two often uncontrolled care issues that lead to acute care hospital admissions, according to CMS.

SNFs routinely struggle with patient admissions to hospitals. A 2014 study concluded that 22 percent of a group of Medicare beneficiaries treated at SNFs in the Carolinas needed emergency care within 30 days of discharge. A total of 37.5 percent needed acute care within 90 days.

"This Initiative has the potential to improve the care for the most frail, most vulnerable Medicare-Medicaid enrollees--long-stay residents of nursing facilities," said Tim Engelhardt, director of the Medicare-Medicaid Coordination Office, in a statement. "Smarter spending can improve the quality of on-site care in nursing facilities and the assessment and management of conditions that too often now lead to unnecessary and costly hospitalizations."

However, the payment structure for SNF apparently has other issues. The CMS issued a report earlier this month suggesting that SNFs were over-utilizing "ultra-high rehab" therapies. And another report released last year concluded that Medicare overpaid SNFs by more than $1 billion in 2012 and 2013.

To learn more:
- read the CMS statement

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