Do Medicare Lump Sum Payments Dictate Hospital Discharges?
Affiliate links may be used in this post. As an Amazon Associate I earn from qualifying purchases. Read the full disclosure policy here
In theory we would all like to believe that the health of hospitalized patients dictates the care of patients as well as the discharge date of a patient. However the unfortunate financial reality of the insurance system including Medicare has caused scrutiny and further investigation into the discharge dates of patients.
Does a patients’ health dictate a hospital discharge or do the Medicare incentives dictate a hospital charge or do Medicare lump sum payment thresholds?
The Wall Street Journal analyzed the patient discharge thresholds for long term care hospitals; hospitals which provide the care and treatment for serious conditions versus general hospitals. The payment for care differs between conditions coded by Medicare and the type of facility which provides the care such as a hospital classified as long term or general care hospital.
What Is A Medicare Threshold And Medicare Lump Sum Date?
Medicare provides different payments and financial incentives depending upon the length of stay in a hospital per condition and type of hospital. A long term care hospital receives less payment for shorter stays, a lump sum payment at a certain date for longer stays and after a patient has passed the lump sum date, no further payment.
The Medicare lump sum threshold date is determined by Medicare.
What Is The Five Sixth Date?
The five sixth date is calculated at five sixth the average hospital stay per diagnosis. The five sixth date determines the lump sum threshold Medicare date.
What Are the Financial Incentives For Medicare Eligibilty?
The WSJ study found a trend existed that a higher percentage of patients were discharged at the most financially beneficial dates for some hospitals. The financially beneficial date is discharge right after the Medicare lump sum date as the facilities would not longer receive any Medicare payments after the lump sum date has passed.
The WSJ Analysis
The study by the WSJ analyzed Medicare claims from 2008-2013. According to the WSJ, there are 435 long term care hospitals in the United States. Two for profit hospital systems were the focus of the analysis due to the discharge dates in relation to the lump sum payment dates. Rebuttals to the WSJ analysis by the for profit hospitals include the observation that because the lump sum date is calculated by averages, it would be statistically feasible that many patients would also be discharged at the lump sum date. Data for non profit hospitals showed more patients were released in the less financially beneficial window before the lump sum payment date than after the date had passed.
A representative for Medicare stated Medicare stresses the quality of care for the patient and not financial incentives for care.
Medicare Supplemental Insurance Excluded
Patients on Medicare Advantage were excluded from the analysis as Medicare Advantage patients are private pay; statistical data, exceptions and exclusions available in the full text of the WSJ article.
Recommended Reading: