Reported Problems in Access to Posthospital Care for Medicare Beneficiaries

GAO testified on its study of Medicare beneficiaries' access to post-hospital care, primarily in skilled nursing facilities (SNF). Medicare post-hospital benefits cover short-term skilled nursing and strictly limit the types and amounts of services. The most frequent problems preventing SNF placement were the Medicare program rules and regulations, the availability of beds, and the need for complex skilled services. Prior to the Medicare prospective payment system (PPS), hospitals could have been providing too much unnecessary and inappropriate care. In shifting to PPS, Medicare removed the financial incentive to provide more health care services than needed and, therefore, the extent to which hospitals discharge patients while they still need acute hospital care has become a primary concern. Under PPS, hospital stays have changed from being generally profitable to relatively unprofitable, which pressures hospitals to discharge patients. There are numerous reports of cases in which hospitals discharged people in unstable medical condition or without adequate provision for post-hospital care. Development of a uniform needs assessment instrument has begun that would evaluate functional capacity and establish the need for post-hospital care services and would also require hospitals to have a discharge planning program as a condition for their participation in the Medicare program. However, important questions remain about identifying and correcting problems related to access, quality, and costs of post-hospital care.