Friday, September 20, 2013

Medicare SNF Coverage

The three day hospital stay prereq for Medicare SNF coverage has been problematic for many beneficiaries, especially with the use of observation status by health care providers..  We talked about this problem in an earlier post, and mentioned the recommendation of the federal Long Term Care Commission that the 3 day stay be eliminated. The Journal of American Medical Association (JAMA) published a Viewpoint article by Dr. Lewis Lipsitz  on September 16, 2013 on The 3-Night Hospital Stay and Medicare Coverage for Skilled Nursing Care. This article offers two patient scenarios, reviews the history of the rule, discusses recent waivers and today's challenges, and concludes that "there is justifiable concern that this rule contributes to suboptimal care and increased costs attributable to avoidable hospitalizations. There is a critical need to update payments and policies that address conditions that cause avoidable hospitalizations."

Among the recommendations in the article, Dr. Lipsitz suggests that "[r]ather than rely on the 3-night stay to identify appropriate patients for skilled nursing and rehabilitative services, ... [CMS] could implement specific functional criteria for [SNF] care, such as an acute decline in mobility, impairment in [ADLs] ... , or presence of delirium, and use the savings from reduced hospitalizations to provide appropriate payments for home-based and nursing home–based treatments."

Becky Morgan

Stetson Law

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