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Prospective payment for Medicare skilled nursing facilities: background and issues.
Health Care Financing Review
|March 6, 1987
Summary
Congress is exploring a Medicare prospective payment system (PPS) for skilled nursing facilities (SNFs). A Health Care Financing Administration study analyzed SNF benefits, costs, and reimbursement issues to inform PPS design.
Area of Science:
- Health Services Research
- Health Economics
- Gerontology
Background:
- Congressional interest in a Medicare prospective payment system (PPS) for skilled nursing facilities (SNFs) prompted a comprehensive study.
- Existing Medicare SNF reimbursement systems present challenges and require evaluation.
Purpose of the Study:
- To analyze the Medicare SNF benefit, including utilization and expenditures.
- To examine the SNF industry and identify problems with current reimbursement.
- To explore the development of a SNF case-mix measure and compare hospital-based and freestanding SNFs.
Main Methods:
- Review of Medicare SNF benefit data.
- Analysis of SNF utilization and expenditure trends.
- Evaluation of current SNF reimbursement policies and challenges.
- Investigation into case-mix measurement for SNFs.
Main Results:
- The study identified significant issues within the current Medicare SNF reimbursement system.
- Differences in case-mix were observed between hospital-based and freestanding SNFs.
- Data was compiled to support the development of a SNF case-mix measure.
Conclusions:
- Findings provide critical insights for designing an effective Medicare SNF prospective payment system (PPS).
- Addressing current reimbursement problems and incorporating case-mix adjustments are essential for PPS implementation.