The CMS will test whether paying skilled-nursing facilities more will reduce avoidable hospital admissions among their long-term-care residents. Industry stakeholders say the move acknowledges the role of post-acute-care facilities in improving quality of care, something integral to the upcoming bundled-payment model.
The new skilled-nursing payment policy would affect those who are in either Medicare or Medicaid, or dual-eligibles.
Participating facilities will be paid to provide additional treatment for common medical conditions, six of which are linked to about 80% of potentially avoidable admissions: pneumonia, dehydration, congestive heart failure, urinary tract infections, skin ulcers and asthma.
Medicare currently pays physicians less for a comprehensive assessment at a skilled-nursing facility than for the same assessment at a hospital. The new model would equalize those payments.
Industry stakeholders were thrilled with the news. “This initiative seems to recognize, better than the ongoing bundling demonstrations, the extremely valuable role post-acute-care providers can play in preventing costly, unnecessary hospitalizations among the most vulnerable of Medicare and Medicaid beneficiaries,” said James Michel, senior director of Medicare reimbursement and policy at the American Health Care Association, which represents skilled-nursing and other long-term-care organizations.
Approximately 250 long-term-care facilities will be selected to participate in the skilled-nursing facility initiative, which will begin in the fall.