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OIG Swing Bed Report: seeing the forest for the trees

By Brock Slabach posted 03-10-2015 09:29 AM

  

The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) once again can’t see the forest for the trees in its recent report on the cost of swing bed services. OIG's attention to a mass of detail prevents it from seeing the bigger picture, a picture that tells an important story regarding rural health:

  1. Rural health is a continuum of services that are dependent on each other to protect our nation’s rural patients. This mosaic of care in rural America saves Medicare 2.7% on a Medicare spend per beneficiary vs. care provided in urban areas.

    This number is significant, amounting to almost $7 billion annually that could be saved if urban communities spent at the same rate as rural. Even in Washington terms, that’s real money.


  2. Swing bed services in critical access hospitals (CAHs), as envisioned by Congress in 1997, ensure safety net access to skilled-nursing services in rural communities that can’t be guaranteed otherwise. High acuity skilled-nursing patients, often turned away from distinct-part nursing facilities can at least be assured they will have a place for care…close to home. This access and intensive service requires resources, an investment in the care continuum described above.

    Additionally, recovery time in a swing bed is a full day shorter than a PPS skilled nursing facility according to the Sheps Center at the University of North Carolina. The Sheps Center prepared a short video explaining why using per-diem rates to calculate Medicare's swing bed cost is incorrect. Two very helpful resources.

     

  3. NRHA member Tim Wolters from Missouri points out a gaping hole in the OIG report. If CAH swing bed services were reimbursed like PPS swing bed services, the cost reports would look far different, with a significant increase in CAH acute care costs. Therefore, Medicare reimbursement for CAH acute care services would increase significantly, eating into the $4.1 billion in savings OIG quotes in Appendix F of the report. It certainly wouldn’t wipe it out, but it wouldn’t be surprising if it erased at least $3 billion off OIG's estimated savings. Stroudwater reported that 90% of incremental costs would be shifted to acute inpatient care, thus confirming this observation.

    In a pleasant surprise, CMS Administrator Marilyn Tavenner agreed that these savings are indeed inflated. 

     

  4. The administrative burden on CAHs to operate a PPS swing bed would be high by adding additional cost of personnel needed to document and code the care provided. It's reported that often a full-time registered nurse is needed just to keep up with the administrative paperwork. It seems the OIG would like to take highly trained RNs, already in short supply in rural areas, just to manage the paperwork. There are those pesky details again.

OIG has peeled back just one layer of the onion and made a shocking conclusion that gives an impression that Medicare swing bed dollars are not spent well. Medicare can save money in many different ways; that isn’t the question. The question truly is what is the right thing for Medicare beneficiaries and ensuring safety net access to valuable skilled nursing services in rural communities? 

Swing bed services are an important part of the beautiful mosaic that makes up rural health care, all of which is being done every day in America with an overall savings to the U.S. Treasury. So, let’s hope that everyone else can see the forest for the trees, because OIG clearly has not.

Call or write your members of Congress and ask them to reject this short-sighted analysis. Join us in Philadelphia, PA for our Annual Conference April 14-17, 2015 to network with colleagues on our strategy to reject these negative proposals!

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