Both Hospitals, Nursing Homes Whipsawed by Payment System

By Gebhart, Fred | Drug Topics, August 2, 1999 | Go to article overview

Both Hospitals, Nursing Homes Whipsawed by Payment System


Gebhart, Fred, Drug Topics


The Balanced Budget Act (BBA) of 1997 has turned into a major pain for hospitals, skilled nursing facilities (SNFs), and their patients. The problem: BBA imposed a capitated prospective payment system (PPS) on Medicare payments to SNFs. But PPS largely ignores the cost of drugs and other non-nursing care for the country's 39 million elderly and disabled Medicare beneficaries. The result: SNFs are refusing to admit patients on expensive therapies, and with no place to discharge patients, hospitals are seeing length of stay-along with cost of care--skyrocket.

"Patients being discharged with TPN (total parenteral nutrition) or tricky IV antibiotic therapies just aren't being admitted [to SNFs]," said Scott Whitmore, director of professional affairs for the Pharmacy Society of Wisconsin. "Longterm care facilities are saying they just don't have the staff or the resources to care for these patients. Under PPS, they don't."

Expensive drug therapy isn't the only reason SNFs are saying No. Occupational therapy, physical therapy, speech therapy, prosthetic devices, and mechanical aids such as ventilators were also left out of the formula used to calculate PPS reimbursements.

Medicare PPS payments are based on resource utilization group (RUG) classification, Whitmore continued. RUG classification is tied to the intensity of resource use, primarily nursing hours or therapy time. There is no direct allowance for differences between patients in terms of disease state, acuity, or underlying conditions. That means RUGs can't account for differences in drug therapy and the resulting cost of care, which are directly related to each patient's medical condition. The more acute the condition or the higher the projected cost of care, the more reluctant SNFs become to accept the patient.

"We're having difficulties placing patients into nursing homes, especially patients on high-cost drug therapies, ' said Bruce Scott, v p.-pharmacy operations for the Allina Health System in Minneapolis. "I don't believe that most hospitals were prepared for the impact of PPS."

The American Hospital Association worries that PPS will reverse the steady downward trend in hospital length of stay. In 1993, said AHA spokeswoman Alicia Mitchell, the average length of stay (LOS) was 6.3 days. In 1997, the latest year for which complete data are available, the average LOS was 5.3 days and continuing to trend downward. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Both Hospitals, Nursing Homes Whipsawed by Payment System
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.