The patient‐driven payment model: A missed opportunity for patient‐centered cancer care

Hospitalized older patients with advanced cancer who were discharged to a skilled nursing facility (SNF) for rehabilitation are unlikely to receive future cancer treatment, have high 30‐day readmission rates, and high mortality yet minimal hospice use. The Medicare SNF benefit was designed to be a b...

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Bibliographic Details
Published in:Journal of the American Geriatrics Society (JAGS) 2021-11, Vol.69 (11), p.3267-3272
Main Authors: Singh, Sarguni, Lum, Hillary D., Kutner, Jean, Fischer, Stacy
Format: Article
Language:English
Subjects:
Aged
Cancer
Female
Health Expenditures
health policy
Hospitalization
Hospitals
Humans
Male
Medicare
Medicare - economics
Mortality - trends
Neoplasms - economics
Neoplasms - therapy
Nursing
Palliative Care
Patient Discharge - statistics & numerical data
Patient Readmission - statistics & numerical data
Patient-Centered Care
Patients
Rehabilitation
Skilled Nursing Facilities - statistics & numerical data
skilled nursing facility
Subacute Care
United States
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Summary:Hospitalized older patients with advanced cancer who were discharged to a skilled nursing facility (SNF) for rehabilitation are unlikely to receive future cancer treatment, have high 30‐day readmission rates, and high mortality yet minimal hospice use. The Medicare SNF benefit was designed to be a bridge and provide short‐term nursing and rehabilitation care for patients after a hospitalization. However, advanced cancer patients churn through the health system cycling between the hospital, post‐acute care facilities, and home in the last months of life. This article explores the potential impact of the patient‐driven payment model, a new SNF reimbursement model introduced by the Center for Medicare and Medicaid Services in 2019, on the experience of older cancer patients. Previously, SNF reimbursement was based on the hours of rehabilitative therapy provided to patients, unintentionally incentivizing SNFs to provide more therapy resulting in long lengths of stay and increased Medicare expenditure. The new patient‐driven payment model bases reimbursement on patient clinical characteristics and resources utilized during their SNF stay. We discuss the impact this payment model might have on cancer patients in the SNF setting and highlight the importance of access to palliative care for this population. We discuss challenges policymakers face in creating palliative care guidelines and developing palliative care delivery models in SNFs. We highlight the policy gaps that remain in creating a system that achieves high‐quality SNF care and conclude by offering suggestions that might better incorporate a patient's illness trajectory, prognosis, and goals of care.
ISSN:0002-8614
1532-5415
DOI:10.1111/jgs.17458