A New Medicare End-Of-Life Benefit For Nursing Home Residents

Huskamp, Haiden A.; Stevenson, David G.; Chernew, Michael E.; Newhouse, Joseph P.

doi:10.1377/hlthaff.2009.0523

Cited by 35 publications

(29 citation statements)

References 12 publications

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“…41 Nursing home palliative care teams could deliver care consistent with patients' and family members' goals while reducing the costs associated with repeated hospital readmissions borne by public programs. [42][43][44] Finally, alternative models for palliative care delivery at smaller (largely rural) hospitals that might not be able to support a full interdisciplinary team-for example, use of palliative care advance practice nurses-need to be developed and evaluated.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

et al. 2011

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Patients facing serious or life-threatening illnesses account for a disproportionately large share of Medicaid spending. We examined 2004-07 data to determine the effect on hospital costs of palliative care team consultations for patients enrolled in Medicaid at four New York State hospitals. On average, patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of patients who received usual care. These reductions included $4,098 in hospital costs per admission for patients discharged alive, and $7,563 for patients who died in the hospital. Consistent with the goals of a majority of patients and their families, palliative care recipients spent less time in intensive care, were less likely to die in intensive care units, and were more likely to receive hospice referrals than the matched usual care patients. We estimate that the reductions in Medicaid hospital spending in New York State could eventually range from $84 million to $252 million annually (assuming that 2 percent and 6 percent of Medicaid patients discharged from the hospital received palliative care, respectively), if every hospital with 150 or more beds had a fully operational palliative care consultation team.

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Section: Discussionmentioning

confidence: 99%

Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

et al. 2011

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“…If acted upon, Huskamp and colleagues' proposal 2 would represent important progress. Its implementation, however, presents challenges.…”

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confidence: 99%

Raising The Standard: Palliative Care In Nursing Homes

2010

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More than two-thirds of long-stay nursing home residents suffer from dementia. This illness has a variable and unpredictable course that renders it a poor fit for the six-month life-expectancy requirement of the Medicare hospice benefit. Palliative care-a form of treatment that strives to match care to patient goals, relieve pain, and improve quality of life for people with chronic or life-threatening illnesses-should be the standard of practice for all elderly dementia patients in nursing homes, regardless of prognosis. Similar principles could apply to other long-term residents with underlying chronic diseases who would benefit from palliative care. Indeed, we would argue that the growing acceptance of the culture-change movement centered on elder-directed goals in nursing homes is promising evidence of the goodness-of-fit of palliative care principles in the long-term care setting. M ore than 70 percent of longstay residents in nursing homes are elderly and have moderate-to-severe dementia.

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“…Medicare regulations prohibit enrollment in the Medicare hospice benefit while the patient is receiving Medicare payment for the SNF stay. 231,232 Thus, the patient must be in a non-Medicare-reimbursed bed (usually private pay) to receive the hospice benefit in a SNF. Medicare reimbursement differs for these services, with SNF care at a higher level than the hospice benefit.…”

Section: Hospice Comanagement In the Snfmentioning

confidence: 99%

Heart Failure Management in Skilled Nursing Facilities

Jurgens¹,

Goodlin²,

Dolansky³

et al. 2015

Circ: Heart Failure

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655H eart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities impair the filling of ventricles or left ventricular ejection of blood. HF disproportionately occurs in those ≥65 years of age.1 Among the estimated 1.5 to 2 million residents in skilled nursing facilities (SNFs) in the United States, cardiovascular disease is the largest diagnostic category, and HF is common. 2,3Despite the high prevalence of HF in SNF residents, none of the large randomized clinical trials of HF therapy included SNF residents, and very few included patients >80 years of age with complex comorbidities.Several issues make it important to address HF care in SNFs. The healthcare environment and characteristics of SNF residents are distinct from those of community-dwelling adults. Comorbid illness unrelated to HF (eg, dementia, hip fracture) increases with age >75 years, and these conditions may complicate both the initial HF diagnosis and ongoing management. [4][5][6] Morbidity and mortality rates are significantly increased for hospitalized older adults with HF discharged to SNFs compared with those discharged to other sites. 7Transitions between hospitals and SNFs may be problematic. 8SNF 30-day rehospitalization rates for HF range from 27% to 43%, 7,9,10 and long-term care residents sent to the emergency department are at increased risk for hospital admission and death.11 The purpose of this scientific statement is to provide guidance for management of HF in SNFs to improve patientcentered outcomes and reduce hospitalizations. This statement addresses unique issues of SNF care and adapts HF guidelines and other recommendations to this setting. MethodsThis scientific statement on HF management in SNFs was developed by a writing group of experts representing nursing, medicine (cardiology, geriatrics, nursing home physicians, and palliative medicine), pharmacology, physical therapy, dietary clinical management, research, and quality of care. Sponsors (the American Heart Association [AHA] and the Heart Failure Society of America) identified specific members of the writing group, and others were selected on the basis of known expertise. A literature search was performed using the key The current document is solely the responsibility of the authors and does not represent the official views of the National Heart, Lung, and Blood Institute or the Department of Health and Human Services.The American Heart Association and the Heart Failure Society of America make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on September 15, 2014, and by the...

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A New Medicare End-Of-Life Benefit For Nursing Home Residents

Cited by 35 publications

References 12 publications

Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

Raising The Standard: Palliative Care In Nursing Homes

Heart Failure Management in Skilled Nursing Facilities

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