The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.

Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE

Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.

Health Expenditures/*statistics & numerical data ; Hospitalization/*economics ; Length of Stay/*economics ; Medicare/*economics ; Patient Discharge/*economics ; Skilled Nursing Facilities/*economics ; Subacute Care/*economics; Aged ; Aged, 80 and over ; Female ; Hospitalization/statistics & numerical data ; Humans ; Length of Stay/statistics & numerical data ; Male ; Medicare/statistics & numerical data ; Patient Discharge/statistics & numerical data ; Retrospective Studies ; Skilled Nursing Facilities/statistics & numerical data ; Subacute Care/statistics & numerical data ; United States

Objective: To investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs.
Data Sources and Study Setting: Retrospective cohort study from 2012 to 2016 using Medicare claims and SNF assessment data, including SNF admissions for Medicare fee-for-service beneficiaries.
Study Design: We first estimate how changes in Medicare's SNF copayment on the 21st day of a patient's benefit period affect length of SNF stay. We then use benefit day on admission as an instrumental variable to estimate the impact of SNF length of stay related to the copayment policy on readmission and Medicare payment.
Principal Findings: From 2012 to 2016, we examined 291 134 SNF admissions. Higher benefit day on SNF admission was strongly associated with shorter SNF stays. A 1-day shorter SNF stay was associated with higher readmission rate within 30 days of hospital discharge (1.5 percentage points; 95% CI 1.4-1.6, P < .001) and within 30 days of SNF discharge (0.9 percentage points; 95% CI 0.8-1.0), lower total Medicare payment for the 90-day episode after hospital discharge ($396; 95% CI 361-431, P < .001), but $179 higher payment for the 90 days after SNF discharge (95% CI 149-210, P < .001), offsetting the lower payment for the shorter index SNF stay.
Conclusions: Medicare's SNF copayment policy is associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy has unintended and negative effects on patient outcomes.
(© 2019 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.)

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T32 AG051090 United States AG NIA NIH HHS; R01 HS024266 United States HS AHRQ HHS; K24-AG047908 United States AG NIA NIH HHS; K24 AG047908 United States AG NIA NIH HHS

Keywords: Medicare payment; postacute care; skilled nursing facility

Date Created: 20191029 Date Completed: 20200127 Latest Revision: 20240501

20240501

PMC6863243

10.1111/1475-6773.13227

31657002