IRF provides skilled nursing care to inpatients on a 24-hour basis, under the supervision of a doctor and a registered professional nurse. The therapy is supervised by doctors and nurses with experience in rehabilitation. How much freedom of choice do they have now? For those who qualify, research proves that individuals treated in acute inpatient rehabilitation facilities (IRFs), like WakeMed Rehabilitation Hospital, have better long-term clinical outcomes than those treated in nursing homes or skilled nursing facilities (SNFs). Nursing Home / Skilled Nursing Facility Care, The Center for Medicare Advocacy Founder’s Circle, Connecticut Dually Eligible Appeals Project, Ossen Medicare Outreach, Education and Advocacy Project, Career, Fellowship & Internship Opportunities, Join the Center for Medicare Advocacy Founder’s Circle. To qualify for this kind of facility … Author information: (1)University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation … For patients who are seeking rehabilitation services, there are typically two options to select: Acute Rehab or Skilled Nursing Facility. However, the Center questions whether freedom of choice is more theoretical than actual. What is the purpose/goal of site-neutral payments? Patients have various options to meet their rehabilitation needs, however it is essential that they be educated on the differences in those options. In a skilled nursing facility, Medicare pays for 100 days per stretch, with the … SUBJECT: Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius . Skilled Nursing Facilities: Daily Medical Care as Needed.  CMS, "BPCI Model 2: Retrospective Acute and Post Acute Episode," http://innovation.cms.gov/initiatives/BPCI-Model-2/index.html.  Model 2 "initiators" are acute care hospitals and physician group practices. The patient must go to a Skilled Nursing Facility that has a Medicare certification within thirty days of their hospital discharge.  Beginning with a 20% sample of patients treated in SNFs and 100% of patients treated in IRFs between 2005 through 2009, the study looked at a subset of patients whose conditions were the same in both settings. About the Ads . Inpatient rehabilitation facility must be licensed under applicable state laws to carry out the skilled nursing care. The biggest change was in patients with hip/knee replacement. Moreover, instead of getting therapy and returning home, patients were more likely to be in the nursing home a full year after their hip fracture; a 200% increase in the rate of nursing home residence was reported by the study after PPS was implemented. As a result, you may need to be transferred to a skilled nursing or rehabilitation facility. A two-year study by Dobson DaVanzo & Associates, LLC, looked at patient outcomes data for the different recovery paths and found that patients treated in rehabilitation hospitals and units have better outcomes, go home earlier and live longer than those treated in skilled nursing facilities. The Medicare Payment Advisory Commission (MedPAC) also recommended at its January meeting, paying IRFs a lower rate for selected patients also treated in skilled nursing facilities (SNFs). The costs of care shifted from inpatient hospital care paid by Medicare to long-term care paid by Medicaid. It is likely that you will choose between an inpatient rehabilitation facility or a skilled nursing facility. The purpose of bundling payments is to support and encourage better coordination of care among different care settings and providers. Post-acute bundling would also likely shift Medicare patients from IRFs to SNFs. With 100,491 matched pairs of patients with the same conditions (representing 89.6% of IRF patients and 19.6% of SNF patients in the study period), Dobson DaVanzo conducted two analyses. It’s the law! MedPAC sees the purpose as paying the same rates to providers that provide the same services "safely and efficiently." If you or a loved one needs nursing home care for rehabilitation, you most likely will be told by your healthcare provider, hospital discharge planner, or assisted living staff member. MedPAC also reported that beneficiaries treated in SNFs rather than in IRFs could have increased cost-sharing. The gravity of your parent’s injuries may warrant a short stay in a rehab center, while more severe injuries may call for long-term solutions at a skilled nursing facility. " The results were "mixed" – SNF patients had higher readmission rates; results were mixed for changes in function; mortality rates were higher for SNF patients in the 30-day period following discharge; and Medicare spending was higher for IRF patients. A post-acute setting could provide "safe" care, but the care might not be of high quality. Tools and Tips. After PPS, the researchers found that, for various reasons, "rehabilitation therapy within the nursing homes was less effective than inpatient therapy before PPS."  Id. A study assessing the outcomes of patients who were treated in inpatient rehabilitation facilities (IRFs) with clinically and demographically similar patients who received their post-acute rehabilitation in skilled nursing facilities (SNFs) finds that IRFs provide better care to their patients over a number of outcome measures – IRF patients live longer, spend more days at home and fewer days in health care institutions, have fewer emergency room visits and, for patients with some diagnoses, fewer rehospitalizations. Nor did it consider the costs of nursing home care paid by Medicaid for patients treated in IRFs or SNFs. IRF admissions for these patients declined from 25.4% of all IRF admissions in 2005 to 14.5% of IRF admissions in 2009. Average length of stay in post-acute care for all clinical categories, Risk of mortality in two years for all clinical categories, E.g., Risk of mortality in two years, hip fracture, E.g., Risk of mortality in two years, hip/knee replacement, E.g., Risk of mortality in two years, stroke patients, Additional days of life for all clinical categories, E.g., additional days of life, hip fracture, E.g., Additional days of life, hip/knee replacement, Ability to remain home without facility-based care for all clinical categories, E.g., Ability to remain home without facility based care, hip fracture, E.g., Ability to remain home without facility-based care, hip/knee replacement, E.g., Ability to remain home without facility-based care, stroke, Emergency room visits for all clinical categories, E.g., Emergency room visits, hip fracture, E.g., Emergency room visits, hip/knee replacement, E.g., Hospital readmissions, hip fracture, E.g., Hospital readmissions, hip/knee replacements. Further, will shared-savings in both models result in less therapy in both care-settings? While providing quality care, skilled clinicians must assess the patient’s activities of daily living (ADL) functions in the presence of illness. Below is a chart to detail the differences between … CMS, "Bundled Payments for Care Improvement (BPCI) Initiative: General Information,", CMS, "BPCI Model 2: Retrospective Acute and Post Acute Episode,", CMS, "BPCI Model 3: Retrospective Post Acute Care Only,", http://www.amrpa.org/newsroom/Dobson%20DaVanzo%20Final%20Report%20-%20Patient%20Outcomes%20of%20IRF%20v%20%20SNF%20-%207%2010%2014%20redated.pdf, http://medpac.gov/chapters/Jun14_Ch06.pdf, http://innovation.cms.gov/initiatives/bundled-payments/, http://innovation.cms.gov/initiatives/BPCI-Model-2/index.html, http://innovation.cms.gov/initiatives/BPCI-Model-3/index.html. The Center believes that site-neutral payments could spell the end of IRFs as an option for Medicare beneficiaries. I. If you do not receive a return call within 24 hours please contact the nursing desk at 906.449.3800. Our skilled nursing program requires a need for skilled nursing 24 hours per day and participation in physical, occupational, speech, and/or respiratory therapy up to 2.5 hours per day 5-6 days per week. Section 3023 of the Affordable Care Act, 42 U.S.C. The following information will help you and your family understand the benefits of rehab hospital care. Providers whose spending is below the target price can keep the savings; providers whose spending is above the target price must repay Medicare the difference between the actual expenditures and the target price. The study has significant implications for site-neutral payment proposals and bundling demonstrations, both of which are likely to shift patients to SNFs. The Center for Medicare Advocacy wants to ensure that IRFs are available to Medicare patients who need, and could benefit from, their services. One major difference between nursing homes and SNFs is the range and depth of medical services available in SNFs. Acute Rehab vs. SNF Patients have various options to meet their rehabilitation needs, however it is essential that they be educated on the differences in those options. History. The patient must have been an inpatient of a hospital facility for a minimum of three consecutive days. Why compare inpatient rehabilitation facilities? Site-neutral payments and the bundling demonstrations appear to undermine the availability of IRFs for Medicare patients who need post-acute care. Rehab hospitals specialize in acute rehab cases. There’s a lot to think about when a patient enters an inpatient rehabilitation facility (IRF). The demonstration waives the three-day hospital stay requirement for participants; the waiver means that patients can get coverage in a SNF without having first been inpatients in the acute care hospital for at least three consecutive days, not counting the day of discharge. Skilled nursing facilities may do the same, though at a less intensive level. To make a referral please fax to 906.449.1923 or contact a clinical liaison at 906.235.7165. Who Needs to Go to a Skilled Nursing or Rehabilitation Facility?  See Dobson DaVanzo & Associates, Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge (July 2014), http://www.amrpa.org/newsroom/Dobson%20DaVanzo%20Final%20Report%20-%20Patient%20Outcomes%20of%20IRF%20v%20%20SNF%20-%207%2010%2014%20redated.pdf. MedPAC recommended paying IRFs the same rates as SNFs, with waivers possible for some IRF requirements. Source: Dobson DaVanzo & Associates, Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge, pages 38-42, Exhibits 4:11-4:14.
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