SNF reimbursement affecting access
September 1, 1999 3 minutes read
SNF reimbursement affecting access
Hospitals forced to provide long-term care
Hospitals are feeling the effects of Medicare’s new prospective payment system (PPS) for skilled nursing facilities, says Susan Pletcher, director of patient access services at the Medical University of South Carolina (MUSC) in Charles ton. "We’re having to hold and maintain long-term patients that need subacute placement. Because we can’t move them through the system, they’re occupying beds that we need for acutely ill patients."
Pletcher is looking for feedback from access colleagues who may have devised solutions for dealing with these patients.
The tightening of reimbursement rules for SNFs has made these facilities leery of accepting patients with complicated care needs, says Kim Egbert, RN, a care manager at MUSC. Since the PPS went into effect in South Carolina in January, "we have had [SNF personnel] come in and actually cost out the care, down to every pill and bandage that will be used, to see whether or not they can take the patient and survive. They subtract cost against reimbursement, and frequently our patients cost too much because of the nature of the patient."
Many patients who are hard to place have been in the intensive care unit and then transferred to a pulmonary care unit, Egbert says. "Many of these patients have multisystem dysfunction. Not only their lungs but other systems are diseased."
Because MUSC is a tertiary care facility, it receives many of these patients from other hospitals, Pletcher says. She recently sent a query to members of the University HealthSystems Consortium in Oakbrook Terrace, IL, asking if their organizations had any transfer agreements in place with these referring facilities. Her idea is that such patients could be returned to their own communities, where there might be "more support people and some way to get the patient into a local skilled nursing home."
The response she has received is that other university hospitals have the same problem and have yet to find a way to deal with it.
She and Egbert are seeking placement for patients who have been at MUSC since November or December, tying up beds needed for acutely ill patients. "[Reimbursement] has long since run out on these patients, their families can’t take care of them at home, and the way the PPS has cut back the reimbursement to SNFs, they can’t afford to take the patient, either," Pletcher says. "The problem is only going to get worse as baby boomers get older, and as we’re better able to treat acute illnesses and more patients survive."
Providing care for patients on ventilators, many of whom will be in this condition for the rest of their lives, is a big part of the problem, she adds. "These are expensive patients to care for, and in the state of South Carolina, there is only one facility that will take patients on ventilators."
Ironically, Medicare’s cost-cutting move with the SNFs is forcing more long-term patients to remain in the even costlier hospital setting, Egbert says. "It’s not really saving health care dollars."
[If you have feedback on this issue, contact editor Lila Moore at (520) 299-8730 or [email protected]. Susan Pletcher can be reached at Medical University of South Carolina, 169 Ashley Ave., P.O. Box 250340, Charleston, SC 29425. Phone: (843) 792-1165.]
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