Question

1. In 1997, Medicare established its prospective payment system for nursing homes. A key component of this payment system is the facility's case mix. Please define what Medicare means by this concept, and how case mix is determined.

2. How is patient assessment used to determine Medicare case mix in a skilled nursing facility, who does this assessment, and what is the assessment called? What are the new parts of this Assessment, and what is the payment mechanism that is determined by the results of this assessment.

3. How will Medicare value-based purchasing impact payments to Medicare certified nursing homes in the future?

Answer 1

a. A concept of Medicare case-mix index that reflects the costliness of hospital’s medicare patient mix. Here the costs are based on the diagnosis related in which the patient is classified and the weight that Medicare has applied to each diagnosis-related group that reflect the patients relative cost. In some cases the medicare patients to whom the payment was made under the prospective payment system has not waived from the medicare reimbursement system. Although the medicare could protect itself from than expected payments per case by adjusting the inequities between the hospitals. As a result the Health Care Financing Administration (HCFA) knows how to deal with the unexpectedly large increase of medicare cases and  sought to assess how the increase resulted from changes in coding practices and what part has change in medical practices as well as changes in medicare patients needs.

b. By the Balanced Budget Act the largest decrease of  payments for nursing home residents has been covered by medicare .The Balanced Budget Act fundamentally changed the way that the medicare pays and skilled the nursing facilities. The fixed amount is paid to the nursing homes and has no extra payments for additional services that has done by them.

c. The medicare payment affect quality of care to the  staffing and for the profit facilities to the higher level of medicare that  exhibit large change in staffing. The medicare rates cannot be viewed in terms of the effect on residents that effects may be experienced throughout the facility of residents. As a result staffing is most responsible for the majority of a operating staff nursing, The medicare  system has a negative effect on staffing and regulatory compliance much more research is necessary to determine for these changes that are associated with worse outcomes and the  investigation could help the guide policy modifications that gives support to the provision of quality that has to be taken to nursing home care.