OIG proposes SNF PPS rates for critical access hospitals

The Medicare program could have saved $4.1 billion over 6 years if it had reimbursed for swing-bed services at critical access hospital (CAHs) using the lower skilled nursing facility (SNF) prospective payment system (PPS) rates paid for similar services at alternative facilities, according to a new report [PDF] from the U.S. Department of Health and Human Services Office of Inspector General (OIG).

Therefore, the OIG recommends that CMS seek legislation to adjust CAH swing-bed reimbursement rates to the SNF PPS rates. CMS, however, does not agree with the recommendation.

Swing-bed usage at CAHs—and the costs associated with that use—significantly increased from 2005 through 2010, according to the OIG. Medicare spending for swing-bed services at CAHs increased to almost four times the cost of similar services at alternative facilities. Of the 100 CAHs sampled by the OIG, 90 had alternative facilities within a 35-mile radius with alternative skilled nursing care available.

“CMS agreed with OIG’s finding that CAHs’ swing-bed use has increased but disagreed with the recommendation [to seek legislation] because of concerns with our findings on the availability of skilled nursing services at nearby alternative facilities and our calculation of savings,” the OIG notes.

Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.