When Patients Should go Directly to a Skilled Nursing Facility

Patients usually end up in a skilled nursing facility as a post-op measure, for further recovery. But there are times when it makes the most sense to go straight there, and when Medicare will still cover the cost.

Accountable Care Organizations

An important development in Medicare reimbursements is the establishment of accountable care organizations, or ACOs. These are alliances between Hospitals and other stakeholders in the care of a patient that tie payments to quality of care. If a patient was treated and not properly followed up, and his health diminished or needs to be hospitalized, the hospital could be penalized. These organizations have been formed to provide accountability for the patient.

In some ways, this new development has hurt skilled nursing facilities, as it carefully monitors the patient’s stay and can cut days that aren’t seen as necessary on their scale. However, elements of the program can offer patients access to skilled nursing facilities that’s otherwise not in use.

The three-day waiver

In general, patients must be in a hospital for 3 days before they get discharged to a skilled nursing facility, or they won’t get their reimbursements. This is to make sure that the patient received proper acute care before the hospital can open up a bed for another patient. There is, however, the opportunity to waive this requirement if it’s for the best of the patient. Hospitals aren’t rushing to sue the waiver, because it they do and the patient gets rehospitalized, the hospital will be penalized.

There is a great use for the 3 day waiver, though, and it benefits both the patient and the skilled nursing facility. This is when a patient comes to the hospital with a complaint, but nothing serious enough to be admitted. Sending the patient home isn’t often a good option, because he needs extra care, even if he doesn’t actually need treatment. Sometimes the patient just doesn’t want to go home, or he might get worse at home. In those cases he often gets admitted for observation, taking up space when the need is not acute.

How it works out for the skilled nursing facility

This is where the skilled nursing facility (SNF) comes in. At the SNF, the patient can get extra care without acute care – exactly what he needs. If he can go straight to the SNF, it’s likely that his needs will be addressed so he doesn’t end up needing a hospital stay. Even more, the total stay for a patient with this type of profile is on average 2 days less than the typical stay for a post-acute care patient, which is another point that’s ultimately cost saving.

ACOs that show they are effectively managing their patients’ care have the opportunity to apply for the 3 day waiver program, and many have already done so.

At Hudson View Rehab Center in Bergen County, New Jersey, we offer the excellent care that a skilled nursing facility can provide for patients recovering and who need more attention than a home setting can provide.