Providers can expect more scrutiny into their discharge practices thanks to research that has found that many Medicare patients appear to be sent home just as financial obligations change.
More patients were discharged on the last day of full Medicare coverage — Day 20 — than on days 19 or 21, researchers at the University of Pennsylvania’s Perelman School of Medicine learned.
For most patients, a Medicare co-pay of more than $150 kicks in on Day 21 of a skilled nursing stay.
The examination of more than 4.5 million stays did not discern whether SNFs or patients, who may be worried about copay affordability, were more likely to initiate a discharge.
“Our results suggest that SNFs are more likely to discharge economically vulnerable patients right before their copay kicks in,” study author Paula Chatterjee, M.D., told McKnight’s.
David Gifford, M.D., senior vice president of quality and regulatory affairs for the American Health Care Association, told McKnight’s the copay “often leads patients and families to request to go home because they can’t afford it.”
Gifford rejected any inference that copay collection issues might negatively impact the quality of care provided. Copays are collected under a Centers for Medicare & Medicaid Services mandate.
Chatterjee said that both the perception of bad debt and the personal financial strain of the copay are likely to affect poor and vulnerable patients more than other patients. She added that it is unclear what the health implications could be from earlier-than-necessary discharges.
The findings were highlighted online in JAMA Internal Medicine.
