Changes in Patient Medical Complexity After Skilled Nursing Facility Payment Reform: A Qualitative Study

Area of Science:

• Healthcare Economics
• Geriatric Care
• Health Services Research

Background:

• The Patient-Driven Payment Model (PDPM) in skilled nursing facilities (SNFs) aims to align reimbursement with patient complexity.
• Understanding SNF leaders' perspectives on admission practice shifts is crucial for evaluating PDPM's impact.

Purpose of the Study:

• To examine SNF leaders' views on changes in admission practices and patient case mix following PDPM implementation.
• To understand variations in SNF responses to PDPM's financial incentives.

Main Methods:

• A qualitative study involving 94 SNF leaders across the US.
• Semistructured interviews were conducted between January 2021 and December 2022.
• Thematic analysis explored leaders' perspectives on PDPM response, case mix changes, and contextual factors, analyzed by SNF quality rating.

Main Results:

• SNFs with a history of complex rehabilitation care reported strategic admission changes post-PDPM, prioritizing medically complex patients.
• Leaders from average to high-quality SNFs often described enhanced screening and admission of patients with higher nursing needs.
• Below-average quality SNFs reported fewer case mix changes, often due to pre-existing practices of admitting complex patients.

Conclusions:

• PDPM's intended shift towards admitting more medically complex patients varied based on SNFs' baseline characteristics and admission patterns.
• Findings highlight the need for nuanced national evaluations of PDPM implementation, considering organizational context.