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Healthcare Policy and Financing in the US Paper

Healthcare Policy and Financing in the US Paper

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Learning Resources

Required Readings

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). New York, NY: Springer Publishing.

  • Chapter 15, “Health Policy and Future Trends” (pp. 447–457)

American Health Care Association. (2019). SNF value-based purchasing (SNF VBP). Retrieved from https://www.ahcancal.org/facility_operations/Pages…

Document: Week 6 Sunnyside Nursing Home Revenue Plan (Excel document)

Required Media

Laureate Education, Inc. (Executive Producer). (2018). Calculating the financial impact of Medicare changes [Video file]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 12 minutes. 

Discussion: Healthcare Policy and Financing in the U.S.

Value-based purchasing and pay-for-performance may continue to affect health policy, future reimbursement, and care-delivery trends in the United States. Outpatient services and post-acute services have recently come under the scrutiny of the Centers for Medicare and Medicaid Services (CMS) to ensure quality of care to ultimately control costs.

Skilled Nursing Facility (SNF) Value-Based Purchasing went into effect on October 1, 2018, for the fiscal year 2019. Nursing homes that offer short-term rehabilitation and get reimbursed by Medicare Part A fall into this category. Specifically, SNFs will have a reduction in Medicare reimbursement based on rehospitalization rates. CMS will look back 2 years and will compare the rehospitalization rate from 2016 to 2018 for year one. Low-performing SNFs can potentially lose 2% on their Medicare fee-for-service (FFS) reimbursement.

Sunnyside Nursing Home, from Week 4, continues to have a 35% readmission rate, so the leadership is anticipating they will be affected by the Medicare discount. Medicare may also consider a reduction in hospice reimbursement as well, potentially 1.8%. Based on these expected changes and current data, you will make a recommendation regarding the future census planning at Sunnyside. Healthcare Policy and Financing in the US Paper

To Prepare:

  • Review the Sunnyside Nursing Home Revenue Plan.
    • Familiarize yourself with the information found on the Overview of Terms tab.
    • Review the Sunnyside Nursing Home CMS Discount Revenue media piece in the resources to assist you in calculating the few missing cells in the Revenue Plan.
    • Study the completed Revenue Plan tab to see the impact of the Medicare changes.
    • The AHCA NJ tab lists the projections for long-term care for New Jersey, where Sunnyside is located. Review the information, especially in the 85+-year-old column to see the impact, if any, on nursing home demand in New Jersey.
  • The American Health Care Association (AHCA) website has several resources to guide healthcare planning in the United States: https://www.ahcancal.org/research_data/Pages/LTC-P… Download and analyze the Long-Term Care (LTC) Patient Projections report for your state. Look for your state to view the impact of the aging population. Pay specific attention to the 85+ trend.
  • Complete the remaining calculations in the Sunnyside Nursing Home Revenue Plan.
  • Based on the information in the report from AHCA and the spreadsheet, what recommendation would you make regarding the future census planning at Sunnyside? Healthcare Policy and Financing in the US Paper

BY DAY 4

Post a comprehensive response to the following:

  • What are some of the future issues and concerns related to healthcare financing in the United States?
  • How might healthcare policy inform financing of healthcare, and what might that mean for the quality of health?
  • How will value-based purchasing affect healthcare providers? Review the information in the Sunnyside Case Study to guide this response. How can a healthcare provider ensure viability in the new value-based paradigm?
  • Would you consider new technologies for Sunnyside to employ to reduce readmissions?

BY DAY 6

Respond to at least two of your colleagues by suggesting at least one way that a SNF can reduce rehospitalizations from SNF and/or how a SNF can continue to be successful as new regulations reduce reimbursement without negatively impacting quality patient care.

 

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Overview of Terms for Week 6 The Centers for Medicare and Medicaid Services (CMS) pays for nursing home services on a specific basis: 1) Medicare-A or Short Term Rehab Med A is covered for patients up to 100 days with the goal of returning home 2) Medicaid is a state-managed program for persons who meet certain financial criteria (usually <$3,000 3) Hospice Care isin aassets) Medicare-reimbursed service for patients who have end-stage illness such as cancer or congestive heart failure and are expected to pass away within 6 months or less Sunnyside Nursing Home in New Jersey Revenue Rates Long-Term Care (LTC) -Private Pay $600/day Long-Term Care (LTC) -Medicaid $285/day Hospice In-patient $495/day Short-Term Rehab Med-A $550/day Average Length of Stay (LOS) for Short-Term Patients at Sunnyside Average LOS Hospice 7 days Average LOS MED-A 18 days Notes: Long-term private pay and Medicaid are residents, as Sunnyside is their home. Hospice and short-term rehab patients are patients, as Sunnyside is not their home. Sunnyside has 200 certified beds with a current average occupancy of 70%, or 140 occupied beds. Average Daily Census (ADC) is the number of residents/patients in beds at midnight each day. Sunnyside Nursing Home CMS Discount Revenue Plan Patient Type Budgeted ADC Overview 140 Budgeted Budgeted Anticipated # Patient Days Annual Patient Annual Revenue CMS Discount Gap Days 51,100 $26,137,650 $214,160 399 Worksheet Category Long-Term Care-Private Pay 40% Long-Term Care-Medicaid 20% Hospice In-Patient 10% Short-Term Rehab Medicare A 30% Totals Budgeted Revenue per patient $600 $285 $495 $550 Budgeted Census 56 28 14 42 Budgeted Annual Census 20,440 10,220 5,110 15,330 CMS Discount Calculation (Hospice Revenue x 1.8%) (Short-term Med-A Revenue X 2%) # Days Gap First take the CMS revenue loss divided by per day rate = the patient days loss in revenue Then calculate the number of unique patients needed to fill the gap in each category: Take the patient days loss in revenue divided by LOS = # of patients needed to fill the gap Average LOS Hospice 7 days Average LOS MED-A 18 days Budegeted Annual Revenue $12,264,000 $2,912,700 $2,529,450 $8,431,500 Anticipated CMS Discount N/A N/A $45,530 # Patient Days Gap N/A N/A 92 ACHA-Long-Term Care Patient Projections Persons State Year NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 Certified Beds (Apr 2016) 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 52550 <55 55-64 65-74 75-84 85+ 9,607 9,537 9,457 9,343 9,219 9,145 9,103 9,079 9,040 8,951 8,892 8,889 8,924 8,978 9,027 9,096 9,168 9,249 9,329 9,399 9,472 9,502 9,501 9,520 9,547 16,484 16,849 17,175 17,471 17,660 17,787 17,808 17,743 17,657 17,523 17,388 17,194 16,938 16,607 16,283 16,077 15,957 15,857 15,718 15,486 15,339 15,376 15,533 15,711 15,863 28,319 29,052 29,579 30,427 31,509 32,422 32,673 33,140 33,841 34,554 35,357 36,107 36,781 37,425 37,850 38,130 38,172 38,037 37,901 37,686 37,464 37,086 36,563 35,891 35,242 40,001 40,818 42,114 43,372 44,504 45,937 48,133 50,149 52,084 54,167 56,096 57,593 58,760 60,561 62,793 64,677 65,392 66,536 68,102 69,730 71,512 73,198 74,745 76,214 77,256 51,096 51,562 51,914 52,154 52,661 53,190 53,836 54,723 55,675 56,822 58,087 60,085 62,766 64,760 66,539 68,803 72,770 76,209 79,055 82,080 84,771 87,579 90,603 93,799 97,508 … Healthcare Policy and Financing in the US Paper