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Association between high discharge rates of vulnerable patients and skilled nursing facility copayments

JAMA Internal Medicine Sep 10, 2019

Chatterjee P, et al. - Researchers ascertained the association between high discharge rates of vulnerable patients and skilled nursing facility copayments. Medicare pays for 100% of postacute care given by skilled nursing facilities (SNFs) during the first 20 days within an advantage period. Nonetheless, on the 21st day, most patients become qualified for a daily co-payment of more than $150. This copayment may offer an important financial burden for some patients—especially those with limited economic means—and encourage them to discharge from SNFs on the 20th day of care on the basis of their financial resources rather than their recovery status. Skilled nursing facilities may also prematurely discharge some patients to circumvent the risk of increasing bad debt from partly uncompensated postacute care. Nevertheless, it is not known whether patterns of SNF discharge are correlated with this variation in Medicare payment responsibility on day 20.
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