We’ve been hearing a lot lately about bundled payments. This new approach will usher in a new era of better healthcare at lower costs, its many advocates insist.
That may or may not actually happen.
Regardless, it’s not hard to see why the shift has many skilled care operators feeling more tense and morose than usual. That’s because many in this field feel they are suddenly being singled out as superfluous middlemen.
One recent report tests this troubling hypothesis. If its results are to be believed, skilled care may not be quite the problem child many would have us believe it has become.
The study, appearing in the New England Journal of Medicine, goes by the name of “Two-year evaluation of mandatory bundled payments for joint replacement.” A better name might have been something along the lines of “How much money can we save by cutting skilled care facilities out of the post-acute picture?”
To be fair, gutting skilled care did produce some modest savings. To be exact, they came to $812 per procedure, or 3.1% of the overall cost. Yes, that’s 3.1%. With all due respect, I’m not sure that the best possible conclusion here is that removing skilled care is what’s needed.
But if reducing costs by $812 per procedure is a great idea, shouldn’t we think about cutting out the hospital middleman when it makes sense? A study appearing in the December issue of the journal Annals of Long-Term Care, “Direct Admissions to skilled care facilities — are you ready?” examines just that.
The author noted that there are both clinical and financial benefits to utilizing SNFs for direct admissions. It would seem that the idea of putting residents in SNFs rather than taking them to emergency departments or to be “observed” in hospitals would make a lot of sense in many instances. Yet we are not hearing much about that option, for some strange reason.
Which sort of begs the question: Is the debate really going to be about providing the best care at the lowest cost, or about making sure those with the most political clout (such as hospitals and doctors) continue to stay in charge?
From the February 01, 2019 Issue of McKnight's Long-Term Care News
