Cost and case-mix differences between hospital-based and freestanding nursing homes

by Margaret B Sulvetta

Publisher: Health Care Financing Administration in [Washington, D.C

Written in English
Published: Pages: 84 Downloads: 930
Share This

Subjects:

  • Nursing homes -- United States -- Rates

Edition Notes

Statementby Margaret B. Sulvetta and John Holahan
ContributionsHolahan, John, United States. Health Care Financing Administration
The Physical Object
Paginationp. 75-84 ;
Number of Pages84
ID Numbers
Open LibraryOL14911020M

Broad case mix and surrogate indicators of quality of care were examined to assess (a) annual variations in these factors in Colorado's nursing homes over a 3-year period and (b) differences between hospital-based and freestanding nursing homes in the State. As these facilities were reimbursed on a cost basis, hospitals faced few financial constraints to owning a SNF, although they were substantially more costly than freestanding nursing homes (Schlenker, Shaughnessy, and Yslas ; Zimmerman et al. ).   The ambulatory healthcare environment. Contrast this scenario with the one faced by community physicians. A physician practice has records that are longitudinal (rather than episode-of-care), and are internal to that practice (rather than all consultants writing into the same chart, as is the case in a hospital record).   Nursing home case-mix differences between Medicare and non-Medicare and between hospital-based and freestanding patients. Inquiry. Summer; 22 (2)–

literature has focused on the related issue of cost and case-mix differences across freestanding and hospital-based SNFs. In a review of the early pre-PPS SNF evidence, Wiener and colleagues () concluded that hospital-based SNF patients were twice as costly per day as. Nursing Home versus Hospital Care You are about to move to a community nursing home. Nursing home care is different from the care you received in the hospital. A nursing home is a home, not a hospital. Some of the differences and similarities are. Because of increasing costs and demand for nursing home care, studies are needed that can better describe the population of users and improve prediction of clinical outcomes and program requirements. The major purpose of this study was to explore the incremental and seven month outcomes of nursing home patients using the Andersen model. The design was : Christine M. Sheehy. (Medicare) cost reports than freestanding homes.5 Instead of reporting direct costs, a hospital-attached home allocates costs between the nursing home and hos-pital using various formulas. For instance, large proportions of costs are allocated based on the amount of square feet in each facility, not on the service provided.

With respect to a hospital-based skilled nursing facility, the Secretary may not recognize as reasonable the portion of the cost differences between hospital-based and freestanding skilled nursing facilities attributable to excess overhead allocations. (c) Adjustments in limitations; publication of data. Shaughnessy PW, Kramer AM, Schlenker RE, Polesovsky MB. Nursing home case-mix differences between Medicare and non-Medicare and between hospital-based and freestanding patients. Inquiry. ; 22(2) PMID: Occupation: Assoc Professor-Clinical. Skilled nursing facility services: Assessing payment adequacy and updating payments Between and , the median occupancy declined slightly but remained high (85 percent). • Volume of services—Medicare-covered admissions per FFS beneficiary decreased between and , consistent with decreases in inpatientFile Size: KB.   The financial department monitors case-mix index (CMI), and in an ideal world, the hospital’s CMI would be as high as possible. A high CMI means the hospital performs big-ticket services and therefore receives more money per patient. To calculate CMI, choose a time period (e.g., one month) to examine. Within that time, take all the DRGs your hospital billed and add up the relative weights (RW).

Cost and case-mix differences between hospital-based and freestanding nursing homes by Margaret B Sulvetta Download PDF EPUB FB2

The ceiling for freestanding homes is currently set at percent of mean costs for freestanding facilities. The ceiling for provider-based SNF's is also set at percent of mean costs for freestanding facilities, plus 50 percent of the difference between the mean Cited by: The costs of hospital-based facilities exceed the costs of freestanding homes regardless of location.

Within urban areas, total average costs for freestanding facilities are estimated to have been $ in fiscal yearcompared with $ for hospital-based facilities, a difference of Size: KB. Cost differences between freestanding and hospital-based skilled nursing facilities (SNF's) are identified and examined in this article.

Although hospital-based and freestanding SNF's have significant differences in terms of location, admissions per bed, percent of Medicare days, occupancy rates, staffing, provisions of rehabilitative services, and patient characteristics, these are. Among the freestanding SNF's, an average 51 percent of all nurses are RN's, compared with 46 precent in hospital-based homes.

These cost differences could be attributable to other differences between hospital-based and freestanding homes.

The effect of case mix and quality on cost differences between hospital-based and freestanding nursing homes. Schlenker R, Shaughnessy P, Yslas I. The considerably higher cost per patient day in hospital-based compared with freestanding nursing homes is well known.

In this study, data from a random sample of 1, patients from 78 freestanding Cited by: 2. presents data on the cost differences between hospital-based and freestanding skilled nursing facilities. Indirect data on possible case-mix differences are presented in the second section, while the third section re-views studies using datasets that directly measure patient characteristics.

We conclude with the policy implications of these studies. On the basis of this analysis, it appears that hospital-based facilities tend to serve more severely ill patients (i.e., have a more difficult case mix) than do freestanding facilities.

Case-mix differences, however, appear to explain less than half of the cost differential between the two types of by: Sulvetta, Margaret B. and John Holahan,Cost and case-mix differences between hospitalbased and freestanding nursing homes, Health Care Financing Review 7, no.

3, A. Dor, Costs of Medicare patients Thorns, William,Proposed criteria for long term care, quality and cost control system, Unpublished manuscript (Nashua, NH).Cited by: We examine case mix-related and other factors behind the cost differences between hospital-based and freestanding SNFs.

Some payment adjustment, notably for nontherapy ancillary services, may be. Two websites that help Americans make informed choices about hospitals and nursing homes have been redesigned and will make more information available to the public, CMS announced on J The two sites – Hospital Compare and Nursing Home Compare – have been enhanced to make navigation easier by users, and have added important Read more →.

Case-mix differences between Medicare and non-Medicare nursing home patients and between hospital-based and freestanding nursing home patients.

A hospital is usually referred to a medical treatment. It is a heath care organization and is largely managed by professional physicians, surgeons and nurses. Whereas, nursing home is a kind of residential health care. It is basically a small private residential accommodation with health management, especially elderly citizens.

The results show that case-mix is the single most important factor affecting both direct-care (nursing staff) and total per diem costs. Although other factors, such as bedsize, occupancy rate, ownership status, county per capita income, and the demand for nursing home care.

assessment and case-mix classification: Cross-national perspectives understanding of the cost differences between nursing homes. It quickly became clear that facilities varied in collected by virtually all U.S.

nursing homes, and case-mix measurement is only one of. Case-mix differences between hospital-based and freestanding nursing homes and between Medicare and non-Medicare skilled nursing patients.

Shaughnessy P, Schlenker R, Kramer A. A summary of selected implications drawn from HCFA-sponsored research in the long-term care by: 7. costs. Medicare recognized differences between hospital-based and freestanding SNF costs through separate cost limits (or caps) for the two types of SNFs.

In effect, the limits were based on the respective cost distributions of hospital-based and freestanding SNFs. The PPS initiated for SNFs in imposed a uniform payment system that did not recognize.

Behavioral differences among nursing home ownership types in respect to patient care costs tended to distinguish government-owned and hospital-based facilities from the freestanding homes rather. Case-mix differences between hospital-based and freestanding skilled nursing facilities: A review of the evidence.

Medical Care 12 - Google Scholar | ISICited by: Nursing home case-mix differences between Medicare and non-Medicare and between hospital-based and freestanding patients. Inquiry ; – Web of ScienceCited by: Case-mix differences between Medicare and non-Medicare nursing home patients and between hospital-based and freestanding nursing home patients were assessed for a sample of patients from 26 nursing homes in six states in Cited by:   Sulvetta, M.B.

"Cost and Case-Mix Differences Between Hospital-Based and Free Standing Nursing Homes." Health Care Financing Review 7, no. 3 (Spring ): 75 - Cited by: NURSING HOMES or NURSING FACILITIES (NFs) • Medicare also covers nursing home care for certain persons who require custodial care, meet a state's means-tested income and asset tests, and require the level-of-care offered in a nursing home.

• Nursing home residents have physical or cognitive (short or long term) impairments and require hour care during their stay. The relationship between the average cost of home health care and the case mix of patients served by the home health agency is investigated using data from Wisconsin's home health care agencies.

In contrast to previous work, case mix is shown to have a significant effect on the home health agency's average costs. develop a Medicare SNF cose-mix measure, and case­ mix differences between hospital-based and freestanding SNF's.

In addition, we discuss the implications ofthe study findings for the design ofa Medicare SNF prospective payment system (PPS). Introduction. Prospective payment systems (PPS's) are increasingly replacing retrospective, cost-based. Nursing home case-mix differences between Medicare and non-Medicare, and between hospital-based and freestanding patients.

Inquiry. ; 22 (2)– Shaughnessy PW, Kramer AM, Pettigrew M. Findings on Case Mix and the Quality of Care in Nursing Homes and Home Health Agencies. Cost and Case-mix Differences Between Hospital-based and Freestanding Nursing Homes.

Health Care Financing Review, (). Discrimination by Nursing Homes against Medicaid Recipients: the Potential Impact of Equal Access on the Industry’s : O. David Gulley and Rexford E. Santerre. se is a critical source of variation in nursing home costs. Previous research has suggested that case mix (Liu et al.

) and payer mix (Dor ) are more important factors, after accounting for wage differences. It is possible that urban and rural SNF costs are determined by the same factors, including size, case mix, payer mix, and the.

Case Mix Reimbursement For Nursing Homes Case Mix Reimbursement For Nursing Homes Schlenker, Robert E. This article is based on a paper commissioned by the Institute of Medicine and presented at the instituteâ s conference on â The Relationshipbetween Reimbursement Policy and Quality of Care in Nursing Homes,â Anaheim, California, November the case mix of nursing homes.

We discuss here that effort; the issues of moving from a case-mix measurement system to a case-mix payment system are addressed in other work we have done (Schneider, Fries, Desmond et al., ).

We strongly advocate separating consideration of the issues of case-mix measurement from those of case-mix payment. One criterion is whether their inclusive provides appropriate incentives for nursing homes and whether nursing homes can develop a system characteristic for residents at little cost to themselves but resulting in increased case-mix payment--that is, whether the system can be "gamed" (Schneider et al., ).

Key words: nursing homes, case mix, long-term care, Medicaid, private pay. (Med Care) The importance of case mix, especially the relationship between case mix and cost, in the nursing home field is now well estab-lished.'-5 This relationship has given rise to several nursing home.

Data from 74 FSEDs (–) in Texas and Colorado were compared to H‐ED data from the – National Hospital Ambulatory Medical Care Survey. In the unrestricted sample, large differences in visit characteristics (e.g., payer and case mix) were found between patients that use FSEDs compared to H‐ by: 9.

This study examined the predictors of total nurse and registered nurse (RN) staffing hours per resident day separately in all free-standing California nursing homes (1,), using staffing data from state cost reports in Cited by: