Rehabilitation Therapy in Skilled Nursing Facilities SNFs: Effects of Medicares New Prospective Paym

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Rehabilitation Therapy in Skilled Nursing
Facilities (SNFs) Effects of Medicares New
Prospective Payment System (PPS)

• Chapin White, Ph.D. Candidate in Health Policy,
  Harvard University
• AcademyHealth Annual Research Meeting, Nashville
  TN
• June 29, 2003
• www.people.fas.harvard.edu/cdwhite/Chapin_White.h
  ome.html
• chapin_white_at_post.harvard.edu

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SNF PPS Basics

• SNFs provide post-hospital rehab, nursing
• most SNFs freestanding, some hospital-based
• SNF PPS per day, casemix adjusted, no outlier
  payments, local wage adjustors
• new incentives services, selection, stinting
• did SNF PPS work?

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SNF PPS Casemix Adjustment

• classification system RUG-III
• classification driven mainly by rehab minutes
  (not patient type or need for services)
• over 3/4 of residents are in a rehab group
• rehab groups Low, Med, Hi, Very Hi, Ultra
• 720 minutes per week ? Ultra

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Payments for Rehab Minutes
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Measures of Rehab

• rehab per resident per day
• residents receiving rehab gt200/day
• universe of MedPAR SNF claims, '97-'00 (6.8m
  stays)
• charges discounted by cost-to-charge ratios

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Rehab Charges per Resident per Day
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Pct Residents Receiving gt200/day
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Comparison with Other Medicare PPSs
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Source McCall, Nelda Komisar, Harriet L
Petersons, Andrew and Moore, Stanley. "Medicare
Home Health before and after the BBA." Health
Affairs, 2001, 20(3), pp. 189-98.
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Source National Center for Health Statistics.
"Health, United States, 2001," Hyattsville,
Maryland Public Health Service, 2001. Table 91.
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Comments

• freestanding SNFs reduced rehab instantly and
  dramatically, especially for-profits
• either waste/fraud in 1997 or stinting today
• hospital-based SNFs didnt respond at all
• freestanding SNFs differ from hospitals
• for-profit, chains, little MD oversight
• are freestanding SNFs acting as patients agents?
• responsiveness puts burden on PPS designers
• are right people going to SNFs, are they
  getting the right services?
• for details see White, C., 2003. Rehabilitation
  Therapy in Skilled Nursing Facilities Effects of
  Medicare's New Prospective Payment System. Health
  Affairs 22(3), 214-223.