Subcontracting Health Care Services: Lessons from Therapist Staffing in Skilled Nursing Facilities

2013 ◽  
Author(s):  
John R. Bowblis ◽  
Christopher Scott Brunt
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Care Services

Care Management and the Transition of Older Adults From a Skilled Nursing Facility Back Into the Community

2011 ◽  
Vol 12 (2) ◽  
pp. 54-59 ◽  
Author(s):  
Adam G. Golden ◽  
Shanique Martin ◽  
Melanie da Silva ◽  
Bernard A. Roos
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Nursing Care ◽  
Care Management ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Management Interventions

After hospitalization, many older adults require skilled nursing care. Although some patients receive services at home, others are admitted to a skilled nursing facility. In the current fragmented health care system, hospitals are financially incentivized to discharge frail older adults to a facility for postacute care as soon as possible. Similarly, many skilled nursing facilities are incentivized to extend the posthospitalization period of care and to transition the patient to custodial nursing home care. The resulting overuse of institution-based skilled nursing care may be associated with various adverse medical, social, and financial consequences. Care management interventions for more efficient and effective skilled nursing facility use must consider the determinants involved in the decisions to admit and maintain patients in skilled nursing facilities. As we await health care reform efforts that will address these barriers, opportunities already exist for care managers to improve the current postacute transition processes.

Competitive Spillovers and Regulatory Exploitation by Skilled Nursing Facilities

2016 ◽  
Vol 19 (1) ◽  
pp. 45-70 ◽  
Author(s):  
John R. Bowblis ◽  
Christopher S. Brunt ◽  
David C. Grabowski
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Medicare Reimbursement ◽  
Care Providers ◽  
Skilled Nursing ◽  
For Profit ◽  
Market Dominance ◽  
Selection Of

Abstract Typically, research on the effect of ownership has considered health care providers in isolation of competitive interaction from other firms. This analysis considers how the selection of Medicare reimbursement codes for skilled nursing facilities varies by ownership and is influenced by the competitive spillovers from market dominance of for-profit institutions. We find evidence that not-for-profits are less likely to code patients into the highest reimbursement categories. Further, as the market becomes dominated by for-profits, both for-profit and not-for-profits increase the share of patients in these high reimbursement categories.

scholarly journals Have we forgotten about the Person with Disabilities for COVID 19 Vaccination – A need of the hour!!!

2021 ◽  
Vol 33 (1) ◽  
pp. 1-2
Author(s):  
Abhijit Vinodrao Boratne ◽  
Karthikayini Sasinthar
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Face Mask ◽  
Health Care Facilities ◽  
Nursing Facilities ◽  
Persons With Disabilities ◽  
Left Behind ◽  
Care Services ◽  
Increased Risk ◽  
The Times

Persons with disabilities (PwDs) are less likely to access health care facilities, education, and employment in their day-to-day life. They are more likely to experience higher rates of neglect and abuse. The present COVID-19 pandemic situation has further affected the PwDs in terms of physical and social neglect. Moreover, the concept of social distancing, using a face mask, and following cough hygiene, which is fundamental in controlling the spread of COVID 19, is likely to be followed by the person with an intellectual impairment since they are highly dependent on their caretakers for their day to day activities. This scenario is even worse with PwDs who are living in congregate settings like residential camps, nursing facilities, and psychiatric institutions where infectivity is very higher. Thus a pronged approach is needed to assure that PwDs are not left behind during the times of pandemic. This paper argues that PwDs, because of their increased risk for exposure to COVID-19 and its consequences of developing morbidity and even possible deaths, should be prioritized in vaccination strategies. Otherwise, they will be left behind, experiencing disproportionate loss of lives and livelihoods, inaccessible health care services, and disconnection from society.

Abstract P306: The Association of Discharge Disposition With 30-Day Readmission After Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shumei Man ◽  
David Bruckman ◽  
Anne S Tang ◽  
Jesse D Schold ◽  
Ken Uchino
Keyword(s):  
Health Care ◽  
Ischemic Stroke ◽  
Home Health Care ◽  
Home Health ◽  
Medical Advice ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Short Term ◽  
Skilled Nursing ◽  
Discharge Disposition

Objective: Readmission after ischemic stroke presents immense social and financial burden on patients, families and society at large. Post-stroke follow-up, a way to prevent readmission, has generally been focused on patients discharged to home with limited attention to those discharged to other facilities. This study aimed to examine 30-day readmission likelihood among patients of different discharge disposition. Methods: We studied patients who were hospitalized for ischemic stroke in states of Wisconsin, Iowa, Arkansas, and New York in 2016-2017 using the Healthcare Cost and Utilization Project State Inpatient Database. Generalized estimating equation was used to study the association of discharge disposition with 30-day all-cause readmission, after adjusting for patient sociodemographics, 23 comorbidities, hospital characteristics, in-hospital complications, and proxies for stroke severity, accounting for in-hospital clustering. Results: Among 52,301 patients hospitalized for ischemic stroke, 45% were discharged to home without home-health-care, 19% to home with home-health-care, 33.5% to rehabilitation and skilled nursing facilities, 1.5% to short-term hospital, and 0.93% left against medical advice. Patients discharged to home accounted for 34.7% of total 30-day readmissions while discharged to rehabilitation and skilled nursing facilities accounted for 40.6% of total 30-day readmissions. Compared to the patients discharged to home without home-health-care which had the lowest 30-day all-cause readmission rate (8.4%), patients with other dispositions were at higher likelihood of readmission: home with home-health-care (11.3%, adjusted odds ratio [OR], 1.18; 95% confidence interval [CI], 1.08-1.28); rehabilitation and skilled nursing facilities (13.2%; adjusted OR, 1.33; 95% CI, 1.22-1.46); short-term hospitals (23.7%; adjusted OR, 3.09; 95% CI, 2.44-3.93); and left against medical advice (18.6%; adjusted OR, 2.2; 95% CI, 1.75-2.83). Conclusion: Patients who are discharged to rehabilitation and skilled nursing facilities after ischemic stroke are at high likelihood of 30-day readmission and should be a focus of discharge planning to prevent events that lead to readmission.

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