Factors Influencing Access of Medicare Beneficiaries to Skilled Nursing Care. Executive Summary

摘要

The project focused on the issue of Medicare beneficiary access to skilled nursing facility (SNF) care. Access to Medicare covered SNF care is a concern for several reasons, including the excess demand for such care, the variability in Medicare certified bed supply across geographic areas, the industry's focus upon Medicare rather than Medicaid, and the relatively higher cost of treating Medicare patients. Four separate analyses conducted through this project examined various aspects of these access issues. The analyses include a study of: the change in Medicare SNF admissions during the 1983-1985 pre/post-PPS time period, at the facility and market levels; the change in medicare SNF casemix during the same period; the determinants of hospital discharges to formal aftercare regardless of payer source; the marginal cost of treating Medicare patients relative to Medicaid and private pay patients; and the implications for nursing home willingness to admit Medicare patients.