Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003. Findings Brief.

摘要

Reimbursement for facility-based post-acute skilled care has been affected by multiple regulatory changes, particularly during the period from 1997 to 2003. Payment for post-acute skilled care received in freestanding or hospital-based skilled nursing facilities (SNFs) was changed from cost-based to a 100% per diem prospective payment system (SNFPPS). Reimbursement for swing bed care in hospitals paid under the prospective payment system (PPS hospitals) changed from a mix of cost-based payment for ancillary services and per-diem payment for routine care to 100% SNFPPS. In contrast, reimbursement for swing bed care in Critical Access Hospitals (CAHs) changed from a mix of cost and per diem to 101% of cost. Now that the reimbursement policy changes begun in the late 1990s have been fully implemented, has the availability of post-acute skilled care stabilized, and how and where is it being provided today. To answer these questions, we used hospital and SNF Medicare Cost Reports linked with county demographic information to analyze changes in facility-based post-acute skilled care availability and use in recent years. Results are presented comparing micropolitan counties (those with an urban core population of at least 10,000 but less than 50,000) to more rural non-core based statistical area (non-CBSA) counties, those with an urban core of less than 10,000 or no urban core. In the case of hospital-based care, we compared the two predominant types of hospitals in rural areas, i.e., PPS hospitals and CAHs.