Lump Sum Payments To Long-term Care Hospitals May Have Created Incentive To Discharge Patients

Yan S. Kim, MD PhD Delivery Science Fellow Division of Research Kaiser Permanente Northern California Oakland, CA 94612MedicalResearch.com Interview with:
Yan S. Kim, MD PhD
Delivery Science Fellow Division of Research
Kaiser Permanente Northern California
Oakland, CA 94612

Medical Research: What is the background for this study? What are the main findings?

Dr. Kim: Long-term care hospitals first emerged in the 1980s as an alternative to lengthy acute-care hospital stays for patients with complex medical problems who need prolonged hospital-level care.  In 2002, Medicare changed its payment method for these facilities from cost-based to a lump sum per admission based on the diagnosis.  Under this system, which is still in place, Medicare pays these hospitals a higher rate for patients who stay a minimum number of days based on the patient’s condition.  Shorter stays are paid much less and longer stays do not necessary generate higher reimbursements.

Using Medicare data, we analyzed a national sample of patients who required prolonged mechanical ventilation – the most common, and among the most costly, conditions for patients in long-term care hospitals – to examine whether this payment policy has created incentives to base discharge decisions on payments.  We found that in the years after the policy’s implementation there was a substantial spike in the percentage of discharges on and immediately after the minimum-stay threshold was met, while very few patients were discharged before the threshold. By contrast, prior to 2002, discharges were evenly distributed around the day that later became the short-stay threshold.  These findings confirm that the current payment policy has created unintended incentives for long-term care hospitals to base the timing of patient discharges on payments and highlight how responsive these hospitals are to payment incentives.

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Booming Need for Long-Term Dementia Care Requires Multifactorial Solutions

Regina Shih PhD Senior Behavioral Scientist at the RAND Corporation.MedicalResearch.com Interview with:
Regina Shih PhD
Senior Behavioral Scientist at the RAND Corporation.

 


MedicalResearch: What are the main findings of the study?

Dr. Shih: RAND identified 25 high-impact policy options to improve the delivery, workforce, and financing of long term care, with a specific eye toward those with dementia and their caregivers. Undertaking these 25 policy options would achieve five goals: increasing public awareness of dementia and its signs and symptoms; improving access to long-term care; promoting high-quality, person-centered care like that offered at Lakeside Manor; providing better support for family caregivers; and reducing the burden of dementia costs on individuals and their families.

Of these 25 policy options, we identified four unique options that have never been identified in any national plan on dementia or long-term care. This is likely because we focused on the intersection between dementia and long-term care, rather than just one or the other. And, rather than only focusing on actions that federal agencies can take, we identified policy options by interviewing 30 different stakeholders in the public and private sectors at the local, state, and national levels. These unique, high-impact policy options have to do with

  • Linking private health insurance with private long-term care insurance;
  • Including home and community-based services in state Medicaid plans;
  • Establishing cross-setting teams focused on returning the person with dementia to the community;
  • Expanding financial compensation to family caregivers.

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Mental Illness: Elderly Patients and Healthcare Utilization

Hugh C. Hendrie, MB ChB, DSc  Professor, Department of Psychiatry, Indiana University School of Medicine Center Scientist, Indiana University Center for Aging Research Research Scientist, Regenstrief Institute, Inc.MedicalResearch.com Interview with:
Hugh C. Hendrie, MB ChB, DSc 
Professor, Department of Psychiatry, Indiana University School of Medicine
Center Scientist, Indiana University Center for Aging Research
Research Scientist, Regenstrief Institute, Inc.

MedicalResearch.com: What are the main findings of the study?

Answer: Our findings of higher rates of emergency care, longer hospitalizations and increased frequency of falls, substance abuse and alcoholism suggest that seriously mentally ill older adults remain a vulnerable population.
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Discharged to Extended Care Facilities After Cardiovascular Surgery: What is Long-Term Outcome?

MedicalResearch.com Interview with: Dr. James R. Edgerton, MD

Cardiopulmonary Research Science and Technology Institute, Dallas, Texas

MedicalResearch.com: What are the main findings of the study?  

Dr. Edgerton: We can use certain patient factors to determine if a patient will be discharged to extended care facility and to predict if he/she will be successfully discharged from that facility to home.
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