McKnight's Long-Term Care News, December 2018, Resident Care, David Grabowski
David Grabowski, Ph.D.

Hospitals have saved money in alternative payment models through reducing institutional post-acute care, especially in skilled nursing. Perhaps even worse, they are potentially headed toward unintended negative consequences, experts say.

In an effort to keep their own finances buoyed, hospitals might begin to send home patients who need institutional rehabilitation, researchers based at Harvard University said in the New England Journal of Medicine in July.

Generating savings for Medicare is an overall positive, one of the researchers, David Grabowski, Ph.D., told McKnight’s. But he warned that healthcare systems will find it increasingly difficult to “discriminate between low-value and high-value” services. 

“We may be eliminating services that don’t improve outcomes,” he said. “We run the risk of cutting valuable services.”

He gave an example of an elderly Medicare beneficiary with pneumonia, for whom a discharge with home health added on could save thousands of dollars when compared to a skilled nursing facility stay. But other cases, such as a pneumonia case where the patient has comorbidities, could end with a hospital readmission, and a skilled nursing facility stay would have been a better choice, both clinically and economically.

The Patient-Driven Payment Model will encourage more complex care. Another big interest is whether SNFs will increasingly struggle to accept Medicaid patients.

“Providers need to educate us about their bottom line,” said Grabowski, who also is a Medicare Payment Advisory Commission member. “We’re seeing closures in rural areas. Without those post-acute dollars, does it put additional pressure on?”