The elderly who need skilled-nursing care aren't having much trouble getting it, the federal government says.
Oh, yes they are, retorts the American Health Care Association, a Washington-based nursing home trade group.
The debate is about whether Medicare's new prospective payment system for skilled-nursing facilities is keeping beneficiaries from getting needed nursing home care. Because of lower rates from the PPS, facilities are turning away certain higher-cost patients.
Both the government and the AHCA say a study released last week by HHS' inspector general's office backs them up.
The inspector general's office asked hospital discharge planners about their experiences placing Medicare patients at nursing homes from January through May.
Some 66% of discharge planners said placement posed no problems. Another 32% said finding placements was somewhat difficult, and 1% said it was very difficult. Despite difficulties, the planners reported success in placing patients.
The inspector general's interpretation of the data: So far so good, but the situation bears watching. The agency will conduct a similar survey next spring.
Blasting the study as flawed, the AHCA nevertheless said the numbers confirm its interpretation of the detrimental effects of the PPS.
"The report underscores what we've been saying for a long time," said Linda Keegan, the AHCA's vice president of public relations. "Thirty-three percent of beneficiaries are having access problems."
The study is sure to play a role in the debate about an AHCA-backed bill that would raise PPS rates. The AHCA has said the increases are needed to protect patients from losing access to skilled care and prevent hospital lengths of stays from ballooning.
The inspector general's study found that compared to the year-ago period hospital lengths of stay for the 10 diagnoses most frequently discharged to skilled-nursing facilities had remained stable.
Nursing homes are less eager to accept patients on intravenous medications, ventilators and other costly services for which the PPS rates are relatively low, the report found.
Some 58% of discharge planners said it had become more difficult to find placements for such patients.
But the study also found that the PPS has boosted demand for other patients. Some 69% of planners said it had become easier to place patients who required extensive rehabilitation, for which the PPS pays the highest rates.
Two other reports by the inspector general provided some evidence that PPS rates for patients with therapy needs may have been set too high. But the reports stop short of recommending rate cuts.
About 13% of physical and occupational therapy provided to nursing home residents under the pre-PPS system was billed improperly to Medicare, the inspector general's office said. The finding, which translates to about $1 billion annually, means that PPS rates were based on inflated costs, the report said.
"Any amount of therapy that is overbilled or conducted inappropriately is a problem," said Peter Clendendin, executive vice president of the National Association for the Support of Long-Term Care. "But there is considerable evidence that PPS rates are underfunded" because they do not adequately account for nontherapy ancillary services, he said.