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Medicare Penalizes Nursing Homes for High Rates of Hospital Readmission

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Medicare has taken an aim to reward nursing homes based on their quality of care rather than quantity, and to penalize the homes that fall short. The recently implemented Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) will redistribute funds to 14,959 skilled nursing facilities across the nation, based on how many nursing home residents are readmitted to a hospital within 30 days of discharge. While the SNF VBP financially encourages quality care, there is concern that nursing homes are now more reluctant to send ill patients to the hospital in order to dodge penalization.

According to CMS data analyzed by Modern Healthcare, approximately 73% of skilled nursing facilities were financially penalized in 2018, while a mere 27% received bonuses.

A nursing home may receive a deduction in funds as severe as 2%, and a bonus as high as 1.6% in Medicare Part A payments. Nearly 20% of skilled facilities received the maximum 2% pay cut, and only 3% of facilities received the full 1.6% bonus.

Benefits of the Skilled Nursing Facility Value-Based Purchasing Program

Apart from focusing efforts on improving quality care, the federal government also had its sights set on reducing hospital readmission, particularly within the month after discharge. According to NPR, roughly 11% of hospitalized patients in 2016 were admitted for problems that could have been avoided if proper medical attention was given.

Additionally, the program aims to deter nursing homes from discharging patients prematurely. Typically, Medicare provides full coverage for 20 days in a nursing home, but stops paying anything after 100 days. For financially strapped nursing homes, the temptation to discharge patients to hospitals becomes all the greater the longer a resident receives care within their walls.

Potential Drawbacks

Despite incentives to improve care for the elderly, some worry that the implementation of the program will actually reduce the level of care residents receive. In an attempt to avoid penalties and deductions, nursing homes may be hesitant to send ill patients to the hospital, even when it is medically necessary.

The idea may be especially attractive to long-term care facilities that are in financial trouble and could benefit from the Medicare incentive money.

To address this, it has been suggested that the government will make necessary adjustments in the future as the program continues, and penalize homes that avoid hospitalizing residents when necessary.

How Do Memphis Nursing Homes Stack Up?

Kaiser Health News developed a home-by-home breakdown of the data, so you can see how nursing homes in your area stack up.

Only two homes in Memphis refrained from getting a pay cut: Kirby Pines Manor (1.34% bonus) and Whitehaven Community Living (0.81% bonus).

Unfortunately, a handful of Memphis nursing homes, several of which we have ongoing cases against, received the nearly full 2% deduction.

The following received a 1.98% reduction in funds from Medicare: Memphis Jewish Home & Rehab; Harbor View Nursing and Rehabilitation Center; Parkway Health and Rehabilitation Center; Quince Nursing and Rehabilitation Center; Rainbow Rehabilitation and Healthcare; and Spring Gate Rehabilitation and Healthcare Center.

The nursing homes listed above only include those with a 1.98% penalty from Medicare. There are many other nursing homes that received a penalty of lower than 1.98%.

Poor treatment and avoidable hospital readmissions among nursing home residents are true problems in care facilities, as noted by the statistics above.

If you or a loved one has been unnecessarily admitted into a hospital or experienced other forms of nursing homes abuse or neglect, including not receiving hospital care when necessary while at a long-term care facility, let our attorneys and staff help you. Call us for a free consultation at (901) 322-4232 to discuss the details of your situation. We are available to answer your questions and help you through a difficult time.