Rooms to spare.

Admissions policies don't hurt SNE access, says QIG

SEVENTY-FOUR PERCENT OF NURSING HOME administrators say a patient's medical condition has become a more important factor in admissions decisions under Medicare prospective payment system, according to a report by the Office of the Inspector General (OIG) of the Department of Health and Human Services.

Fifty-three percent of administrators surveyed by the OIG said they are less likely to admit patients who require expensive supplies or services such as intravenous medications, ventilators, feeding tubes, wound care, or dialysis. At the same time, 46 percent of administrators said they are more likely to admit patients who require special rehabilitation services such as physical, occupational, or speech therapy. Administrators also report, however, that access to nursing home care still is available to Medicare beneficiaries in their respective areas, most likely "because beds are available. Few administrators attribute any placement difficulties to the prospective payment system," declared Inspector General June Gibbs Brown in submitting the report October 13 to Health Care Financing Administrator Nancy-Ann DeParle, who requested the study.

The findings in the report, Early Effects of the Prospective Payment System on Access to Skilled Nursing Administrators' Perspective, are consistent with those of hospital discharge planners in another recently issued OIG report. They are based on interviews with 57 administrators from SNFs that accept Medicare Part A patients in the 4 states with the most SNF beds (California, Texas, Illinois, New York); 2 states (Mississippi, Maine) of the 4 currently using a Medicaid demonstration prospective payment system; and 2 states (Virginia, Connecticut) randomly selected from the remaining 40 contiguous states. The OIG says the state sample is the same one used for three related nursing home studies it conducted.

                              Added scrutiny
                    Many nursing home providers surveyed
                      by HHS have tightened admissions
                      policies since the advent of PPS,
                   saying they now "scrutinize patients'
                      medical status" more carefully.
no change                   26%
tighter admissions policies 74%
Source: HHS Office of the Inspector General