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The new Medicare program will change the amount of payments in one year to 14,959 nursing homes in the United States, based on the number of withdrawals that residents made in the last fiscal year in hospitals in the 30 days after departure.
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The new Medicare program will change the amount of payments in one year to 14,959 nursing homes across the United States, based on the number of times their residents would have been in hospital in the United States. 30 days after their departure.
BSIP / Getty Images
The federal government took another step this week to reduce the number of readmissions of preventable patients to hospitals. The move targets net household outcomes by reducing one-year payments to nearly 11,000 nursing homes and offering bonuses to nearly 4,000 others.
These financial incentives, determined by the readmission rates of each household, greatly enhance Medicare's efforts to pay for medical expenses.
Up to now, Medicare limited this type of incentive primarily to hospitals, which have become accustomed to coping with the financial repercussions if too many of their patients were readmitted. , suffer from infections or other injuries or die.
"For some retirement homes, this could be a significant amount of money," says Thomas Martin, Director of CarePort Health's Post-acute Care Analysis, which works for both hospitals and nurses. houses. "Many operate on very small margins."
New Medicare program changes the value of payments to 14,959 specialized nursing homes, based on the frequency of their residents [19659008] Hospitalizations of Nursing Home Residents, Though Decreased in Recent Years, Remain a Problem: Nearly 11% of Patients in 2016 Sent to Hospital for Problems That Could Have Been Avoided These premiums and penalties are also intended to deter care centers from releasing patients too quickly, which is financially tempting, as Medicare covers only the first 20 days of a drug. stay and usually stop paying after 100 days. 19659015] During this fiscal year, which began on October 1 and ends in late September 2019, the best performing homes will receive 1.6% more ch Medicare patient than they would otherwise have. The worst performing homes will lose close to 2% of each payment. The others will be in between. (You can view the scores of nursing homes in your area here.)
For-profit nursing homes, which account for two-thirds of the country's facilities, face larger reductions than non-nursing homes. profit-driven and government-owned data analysis found by Kaiser Health News.
In Arkansas, Louisiana and Mississippi, 85% of homes will lose money, according to the analysis. Premiums will be awarded to more than half of the states of Alaska, Hawaii and Washington.
Overall, 10,976 nursing homes will be penalized, 3,983 will receive premiums and the others will suffer no change in payment, according to KHN analysis.
Medicare cuts payments to 12 of 15 retirement homes run by Otterbein SeniorLife, a non-profit, non-profit organization in Ohio. Pamela Richmond, Chief Strategy Officer at Otterbein, said that most of her readmissions took place in patients after they returned home, and not while they were in the nursing home. Otterbein plans to lose $ 99,000 during the year.
"We are extremely disappointed," Richmond said of the penalties. She says Otterbein has started following up with former patients or home health agencies who are sending nurses and caregivers to their patients to take care of them. If there are signs of problems, Otterbein will try to arrange care or bring patients back to the nursing home if necessary.
"to organize and coordinate better care after they leave," said Richmond.
Congress created Specialized Value Nursing Incentive Program in the Health Care Access Protection Act, 2014. By awarding premiums and penalties, Medicare assessed the performance of each institution in two ways: by comparing its hospitalization rates during the calendar year 2017 with other institutions and their degree of variation relative to the 2015 calendar year.
The institutions received scores of 0 to 100 performances and 0 to 90 for their improvements, the higher of the two scores was used to determine their overall score.
Medicare does not measure t In some regions, the majority of Medicare beneficiaries rely on them to pay for their care.
Medicare will redistribute $ 316 million from low performing households to high performing households. Medicare expects to retain an additional $ 211 million that it would otherwise have paid to nursing homes if the program did not exist.
New payments increase the additional pressures exerted by Medicare programs and national Medicaid programs on lowering readmissions to hospitals. [19659008] "Qualified facilities worked on this and knew it was going to happen," said Nicole Fallon, vice president of health policy and integrated services at LeadingAge, an association of senior care providers. non-profit.
The American Health Care Association, a group of retirement homes, states in a written statement that it supports the program and is pleased to note that more than a quarter of establishments have received bonuses.
Although most researchers believe that the number of readmissions can be reduced, some advocates of consumer rights are concerned that retirement homes will be reluctant to admit very infirm residents or re-hospitalize patients even when they are not safe. they will need medical care.
Patricia McGinnis, Executive Director of California Advocates for Nursing Home Reform, based in San Francisco.
Fallon declares that Medicare will eventually penalize homes that have done everything possible. to avoid hospital returns. But because of the program's design by Congress, Medicare will still have to punish a large number of homes.
"There will always be winners and losers, even if you make good progress," says Fallon. "When did we achieve everything we can achieve?"
Meanwhile, Medicare is seeking to extend financial incentives to other types of providers. Since 2016, he has been testing quality bonuses and penalties for home health agencies in nine states. Richmond, the management of the retirement home, applauded this type of expansion.
"There are a lot of people in this chain of" institutions taking care of patients at different stages, "she said," and we all have to work in a common direction. "
Kaiser Health News is a non-profit news service, is an independent editorial program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente." Elizabeth Lucas, editor-in-chief of Kaiser Health News. KHN Data contributed to this report.
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