Study: Nursing homes push dying into pricey rehab
Nursing home residents are increasingly spending time in rehabilitation treatment during the last days of their lives, subjected to potentially unnecessary therapy that reaps significant financial benefits for cashstrapped facilities, a study shows.
The proportion of nursing home residents who received “ultrahigh intensity” rehabilitation increased by 65 percent between October 2012 and April 2016, according to research published this month by the University of Rochester.
Medicare defines “very high” therapy as almost 9 hours per week, and “ultrahigh” therapy as more than 12 hours per week. Some residents were found to be treated with the highest concentration of rehabilitation during their last week of life.
The study analyzed data from 647 New York-based nursing home facilities and 55,691 long-stay decedent care, a federal insurance residents, with a specific program, doles out lofty focus on those who received reimbursement checks to very high to ultrahigh reha- nursing homes with patients bilitation services — includfacing the most complex and ing physical, occupational time-intensive rehabilitation. and speech therapy — during Temkin-Greener said forthe last 30 days of their life. profit nursing homes were
Such treatments garner more than two times as the biggest payouts from likely to use high-to-ultra- insurers. high intensity therapy than
The study sourced data nonprofit homes. from New York nursing “There’s a possibility homes’ Minimum Data Set that nursing homes know assessments, which track a a patient is approaching end patient’s health status and of life, but the financial pres- sociodemographics, as well sures are so high that they as the Centers for Medicare use these treatments so they and Medicaid Services’ (CMS) can maximize revenue,” she Nursing Home Compare websaid. site. Alternatively, “if it’s being
The findings raise ques- driven by a failure to rections about financial motives, ognize that a resident is said Helena Temkin-Greener, approaching end-of-life, the lead author of the study then it calls for improving and a professor at the Unithe skills of nursing home versity of Rochester Medical teams,” she said.
Center Department of PubThe New York State lic Health Sciences. Medi- Department of Health, the Office of the New York Attorney General, and the Centers for Medicare and Medicaid Services didn’t return requests for comment.
AHCA pushes back
“It is important for [skilled nursing facility] providers and their care teams to consider the risk-benefit of potential therapy interventions and dosage relative to the resident’s current health status,” said Daniel Ciolek, associate vice president of therapy advocacy at the American Health Care Asso- ciation, which represents most of the country’s forprofit nursing homes.
Ciolek noted the AHCA has long promoted efforts to redesign the skilled-nurs- ing facility payment system to “be based on care needs rather than service delivery.”
Associations representing nonprofit nursing homes ogy, which he said defined she said, that points toward a very narrow SNF popula- nursing homes seeking to tion of long-stay residents. profit off of helpless resiHe said the study gives a false dents. impression that the findings “If ultrahigh therapy is apply to all SNF admissions. good for patients at end of Temkin-Greener said the life, why are only for-profits research “clearly focused using it?” Temkin-Greener on long-term decedent resasked. “These people are idents for whom high-inten- using high-intensity services sity therapy delivered at the without justification.”” end of life is not indicated. Forthcoming Medicare However, with about 30 per- payment and policy changes cent of all Americans dying for skilled nursing facilities in nursing homes, this can may end the very incentives hardly be described as a ‘very that encourage high-intennarrow SNF population.’” sity treatment. Starting Oct.
The study of New York 1, 2019, CMS will implement facilities doesn’t bode well a new “Patient-Driven Payfor how nursing homes ment Model” which will throughout the U.S. are determine payments based agreed. treating dying residents — on a patient’s condition and
“Reimbursement policy given that most states have health needs rather than on should be driven by what it less stringent nursing home the amount of care provided costs to provide high-quality regulatory oversight than or the intensity of treatment. care to all Medicare benefi- New York. The Medicare Payment Adviciaries,” said Aaron Tripp, “This is a nationwide prob- sory Commission, an indethe director of long-term care lem,” said Paul Ginsburg, pendent U.S. federal body, policy and analytics at Lead- director of the USC-Brook- applauded the decision. ingAge, an organization that ings Schaeffer Initiative for “It will level the playing represents more than 2,000 Health Policy. “I would susfield so there won’t be the nonprofit nursing homes. pect this isn’t unique to New financial incentive to have “If someone comes into a York, since these distortions therapy drive payment as skilled nursing home facility in our payment system are much as it does today,” with high degrees of medical national.” Tripp, of the nonprofit induscomplexity, but not in need Rehabilitation therapy try group, said. “In a perof rehab, they shouldn’t be has proven to be incredibly fect world, the new model at a disadvantage because beneficial to patients when would help mitigate this. But the system provides incenproperly prescribed, Temit’s too early to say.” tives for patients in need of kin-Greener noted, but with Ginsburg said the decline high therapy.” those approaching death, in nursing home occupancy
LeadingAge has criticized high-intensity treatment likely isn’t contributing to the current patient classifi- might be preventing staff the increase in high-intencation system, which deterfrom providing more approsity treatment. mines reimbursement levels priate end-of-life care, such “It doesn’t matter if the for skilled nursing facilities as hospice or palliative care. beds are empty or not,” he (SNF), since it was rolled It may also be accelerating said. “The incentives to do out in 2010. the residents’ decline. too much rehabilitation exist
Ciolek pushed back against There’s one particular whether a facility is underthe new study’s methodol- piece of data from the study, or over-occupied.”