1 in 3 SNFs in bundled payment test areas won't qualify for 3-day stay waiver

Hospitals can't waive the three-day stay unless patients go to an SNF with three or more stars
Hospitals can't waive the three-day stay unless patients go to an SNF with three or more stars

One in three skilled nursing facilities under Comprehensive Care for Joint Replacement initiative testing will be shut out from a waiver of the three-day stay rule due to their star rating, according to a new published report.

Under the Centers for Medicare & Medicaid Services' final bundled payment model, released last week, a waiver to the three-day stay rule can be granted only if a patient is discharged to an SNF with a Five-Star Quality Rating of three or more stars for at least 7 of the previous 12 months.

That restriction could disqualify 1 in 3 SNFs in the joint replacement model's 67 test locations from receiving the waiver, according to a new analysis of CMS data from Modern Healthcare. The analysis estimates that in some test areas, up to 80% of facilities would be barred from the waiver due to their low star rating.

The model's test locations, cut to 67 geographic areas from the original proposed 75, include Los Angeles, New York and Seattle. In 11 of those areas, including Austin, TX and Kansas City, MO, less than half of the nursing homes have adequate star ratings to accept CCJR patients.  

Many hospitals participating in the bundled payment model have begun forming networks of preferred nursing homes based on a facility's rating, staff tenure and other criteria, Modern Healthcare notes.

The joint replacement bundled payment model goes into effect in April 2016. The three-day stay waiver for skilled nursing facilities won't go into effect until the second year of the model.