A new report by the U.S. Department of Health and Human Services' Office of Inspector General determined that the government could save billions of dollars a year if the swing beds at critical access hospitals were reimbursed at rates comparable to those of skilled nursing facilities.
Under the current reimbursement rules, patients at critical access facilities do not have to leave their beds in order to receive skilled nursing services instead of acute care services, but the hospital is paid at the higher inpatient hospital rate.
Critical access hospitals have been struggling financially for years, but they have also been the subject of a vigorous debate regarding how they should receive their designation and even if they are properly designed.
The OIG report found that the government would have saved $4.1 billion over a six-year period if those hospitals had their swing beds reimbursed at the skilled nursing propsective payment rates. OIG reached that conclusion by reviewing swing-bed Medicare claims data at critical access hospitals and at alternative facilities between 2005 and 2010.
Over that period of time, OIG determined that swing bed utilization at critical access hospitals grew considerably and Medicare spending on those beds increased on average to four times the cost of similar services at alternative facilities.
The analysis conducted by the OIG led to this conclusion: 90 percent of the critical access hospitals it sampled for the study had alternative facilities with skilled nursing care available within a 35-mile radius.
As a result, the OIG has asked the Centers for Medicare & Medicaid Services (CMS) to seek federal legislation that would address the issue. However, CMS balked at the request, according to the report, because it was concerned that the OIG's conclusions regarding the availability of nearby SNF services may not be accurate.
To learn more:
- read the OIG report (.pdf)