Medicare Usage Changes in Nursing Homes and Their Impacts on Long-Stay Resident Outcomes

2021 ◽  
pp. 073346482110136
Author(s):  
Michael Lepore ◽  
Daniel H. Barch
Keyword(s):  
Nursing Homes ◽  
Functional Decline ◽  
Skilled Nursing Facility ◽  
Spillover Effects ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Improved Outcomes ◽  
National Trends ◽  
Daily Pain

Medicare provides skilled nursing facility (SNF) coverage for short-stay rehabilitation in nursing homes (NHs) at a better rate than Medicaid covers long-term NH care. National trends of increasing Medicare days culminated in 2010/2011 with a reduction to the SNF rates. Before the cuts, NHs that increased SNF days also improved outcomes for long-stay residents, including pain, pressure ulcer, and functional decline outcomes, suggesting spillover effects of SNF days. We replicated the prior study to determine how changes in SNF days and long-stay outcomes related following the rate cut. From 2011 to 2014, SNF days decreased and all three study outcomes improved. Spillover effects were not consistently observed. Decreasing SNF days was associated with increasing percentages of long-stay residents with daily pain and with decreasing percentages of long-stay residents getting pressure ulcers. Research on these associations in more recent years is needed to determine whether they persist and to inform practice.

scholarly journals Evaluation of Risk-Adjusted Home Time After Acute Myocardial Infarction as a Novel Hospital-Level Performance Metric for Medicare Beneficiaries

Circulation ◽  
2020 ◽  
Vol 142 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Ambarish Pandey ◽  
Neil Keshvani ◽  
Mary S. Vaughan-Sarrazin ◽  
Yubo Gao ◽  
Saket Girotra
Keyword(s):  
Mortality Rate ◽  
Skilled Nursing Facility ◽  
Hospital Performance ◽  
Hospital Level ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Performance Metric ◽  
Level Performance ◽  
Medicare Claims Data

Background: The utility of 30-day risk-standardized readmission rate (RSRR) as a hospital performance metric has been a matter of debate. Home time is a patient-centered outcome measure that accounts for rehospitalization, mortality, and postdischarge care. We aim to characterize risk-adjusted 30-day home time in patients with acute myocardial infarction (AMI) as a hospital-level performance metric and to evaluate associations with 30-day RSRR, 30-day risk-standardized mortality rate (RSMR), and 1-year RSMR. Methods: The study included 984 612 patients with AMI hospitalization across 2379 hospitals between 2009 and 2015 derived from 100% Medicare claims data. Home time was defined as the number of days alive and spent outside of a hospital, skilled nursing facility, or intermediate-/long-term acute care facility 30 days after discharge. Correlations between hospital-level risk-adjusted 30-day home time and 30-day RSRR, 30-day RSMR, and 1-year RSMR were estimated with the Pearson correlation. Reclassification in hospital performance using 30-day home time versus 30-day RSRR and 30-day RSMR was also evaluated. Results: Median hospital-level risk-adjusted 30-day home time was 24.0 days (range, 15.3–29.0 days). Hospitals with higher home time were more commonly academic centers, had available cardiac surgery and rehabilitation services, and had higher AMI volume and percutaneous coronary intervention use during the AMI hospitalization. Of the mean 30-day home time days lost, 58% were to intermediate-/long-term care or skilled nursing facility stays (4.7 days), 30% to death (2.5 days), and 12% to readmission (1.0 days). Hospital-level risk-adjusted 30-day home time was inversely correlated with 30-day RSMR ( r =−0.22, P <0.0001) and 30-day RSRR (r =−0.25, P <0.0001). Patients admitted to hospitals with higher risk-adjusted 30-day home time had lower 30-day readmission (quartile 1 versus 4, 21% versus 17%), 30-day mortality rate (5% versus 3%), and 1-year mortality rate (18% versus 12%). Furthermore, 30-day home time reclassified hospital performance status in ≈30% of hospitals versus 30-day RSRR and 30-day RSMR. Conclusions: Thirty-day home time for patients with AMI can be assessed as a hospital-level performance metric with the use of Medicare claims data. It varies across hospitals, is associated with postdischarge readmission and mortality outcomes, and meaningfully reclassifies hospital performance compared with the 30-day RSRR and 30-day RSMR metrics.

scholarly journals HIV as a chronic disease: Implications for long-term care at an AIDS-dedicated skilled nursing facility

2000 ◽  
Vol 77 (2) ◽  
pp. 187-203 ◽  
Author(s):  
Peter A. Selwyn ◽  
Joseph L. Goulet ◽  
Susan Molde ◽  
Janet Constantino ◽  
Kristopher P. Fennie ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Long Term Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing

scholarly journals Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020

2020 ◽  
Vol 69 (13) ◽  
pp. 377-381 ◽  
Author(s):  
Anne Kimball ◽  
Kelly M. Hatfield ◽  
Melissa Arons ◽  
Allison James ◽  
Joanne Taylor ◽  
...  
Keyword(s):  
Long Term Care ◽  
Skilled Nursing Facility ◽  
King County ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing

scholarly journals Profound Autonomic Instability Complicated by Multiple Episodes of Cardiac Asystole and Refractory Bradycardia in a Patient with Anti-NMDA Encephalitis

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Stephanie R. Mehr ◽  
Roy C. Neeley ◽  
Melissa Wiley ◽  
Avinash B. Kumar
Keyword(s):  
Skilled Nursing Facility ◽  
Autoimmune Encephalitis ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Autonomic Instability ◽  
Life Threatening ◽  
Adults And Children ◽  
Central Hypoventilation ◽  
Children First

Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) is autoimmune encephalitis primarily affecting young adults and children. First described about a decade ago, it frequently manifests as a syndrome that includes progressive behavioral changes, psychosis, central hypoventilation, seizures, and autonomic instability. Although cardiac arrhythmias often accompany anti-NMDARE, the need for long-term electrophysiological support is rare. We describe the case of NMDARE whose ICU course was complicated by progressively worsening episodes of tachyarrhythmia-bradyarrhythmia and episodes of asystole from which she was successfully resuscitated. Her life-threatening episodes of autonomic instability were successfully controlled only after the placement of a permanent pacemaker during her ICU stay. She made a clinical recovery and was discharged to a skilled nursing facility after a protracted hospital course.

The recreation therapist versus the certified activity director: Which professional receives fewer deficiencies in long-term care facilities?

2010 ◽  
Vol 9 (1) ◽  
pp. 9-14
Author(s):  
Timothy J. Legg, PhD, CNHA, GNP-BC, FACHCA ◽  
Sharon A. Nazarchuk, PhD, MHA, RN ◽  
Deborah Adelman, PhD, RN, CNS
Keyword(s):  
Long Term Care ◽  
Skilled Nursing Facility ◽  
Therapeutic Recreation ◽  
Professional Group ◽  
Recreation Therapy ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Care Facilities

The literature reports no studies that sought to determine which professional group (certified therapeutic recreation therapist versus certified activity director) achieves fewer survey deficiencies in the skilled nursing facility. This article will examine the scant and dated literature that is available to demonstrate which of these activity professionals has superior outcomes specific to the OBRA ’87 requirements. The article concludes with an articulation of the need for the discipline of recreation therapy to involve itself in outcomes research specific to which of the two disciplines better achieves the objectives of OBRA ’87.

Factors Associated with Short- Versus Long-Term Skilled Nursing Facility

1990 ◽  
Vol 38 (10) ◽  
pp. 1139-1144 ◽  
Author(s):  
Susan K. Bonar ◽  
Mary E. Tinetti ◽  
Mark Speechley ◽  
Leo M. Cooney
Keyword(s):  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Factors Associated
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