Case Study: Skilled Nursing Facilities
Skilled nursing facilities continue to grow in the United States. It is currently funded primarily by Medicare, Medicaid, and private pay. What thoughts do you have in reforming the methods for paying for long term care services? How might other settings for long term care impact this? (Utilize the internet and library for additional information) Skilled nursing facilities (SNFs) are subacute hospital setting where care is administered after admission the an acute care facility. The general payment method for SNFs has been per diem payments. For cost reporting periods beginning on or after July 1, 1998, SNFs are paid a comprehensive per diem under a prospective payment plan This SNF prospective per diem payment represents Medicare’s payment …show more content…
Many of them include the payments that would involve payments to SNFs. Bundle payment programs of which there 48( in 2017) create an episode of care. In this episode the post acute care services would be included in the payment. This program offers several potential strategic opportunities for providers, such as reducing costs, improving quality, providing a platform for more meaningful physician engagement and allowing hospitals to gain a better understanding of the total cost of care. Modern health 99 article Under this scenario a hospital or ACO would contract for post acute services. This could reduce cost and improve quality. The SNF would most likely be paid a sum as part of that episode care. The 100 day rule would be removed. Also hospitals would need to determine where the best and most efficient care in the community is occurring prior to contracting will local SNFs. The hospital or ACO would choose the SNFs based on metrics involving care. ( aha article). Critics of the bundled payment program feel that bundle payments are prolonged fee for service and will not result increased efficiencies.( Harvard …show more content…
ACOs as they develop may eventually evolve into total cost of care contracting. This type of payment system will pay a per member per month capitation rate and that will include all services. This would also include post acute care. This will have several effects. The first maybe that the patients no longer are discharged to SNFs , but less acute patients maybe discharged with home health care, which reduces cost. The other is again the overall review of the SNF facilities for their efficiencies and rate the SNFs based on many factors. Specific alignment with SNFs that produce the best care at the lowest
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624 Words | 3 PagesThese types of care are covered when deemed medically necessary during a benefit period that begins when a patient is admitted as an inpatient in a hospital or skilled nursing facility and ends when they haven’t received care for 60 consecutive days. Each time a patient receives care during a new benefit period, the beneficiary must pay the inpatient deductible and copayments for all services during that beneficiary period. The duration of the benefit period determines the amount of deductibles and copayments and is due by day 60. The benefit period provides coverage up to 90 days, after which, a beneficiary who still needs care can use their nonrenewable lifetime reserve of up to 60 additional days of inpatient hospital care. After a beneficiary has exhausted all of their care days, whether they use the covered 60 days or have exhausted their additional lifetime reserve, they are responsible for all costs associated with additional care for that benefit
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