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Respond to your classmates and explain if their analysis would be applicable to one of the other PACs described in the chapter.
The Four PACS (Post-Acute Care)
Skilled nursing facilities (SNFs)
Long-term care hospitals (LTCHs)
Inpatient rehabilitation facilities (IRFs)
Home health agencies (HHAs) (MedPAC 2017a, xvi)
Post-acute care facilities are meant to provide various rehabilitation services after an injur or illness. Most post-acute services are provided after discharge from an acute care facility. LTACHs or LTCHs are long term care hospitals that treat patients who require an extended hospital stay. These facilities treat the patients that need the extended stay and treatments but no longer require invasive or extensive diagnostic procedures. They no longer require intensive care. An LTCH is for the patient that still requires the clinical care. Like acute care hospitals, LTCH services are covered under Medicare part A. An average length of stay is 30 days. In fact, the minimum stay in 25 days in order to receive Medicare reimbursement (AHA, 2020).
LTCHs are the compromised between acute care hospitals and skilled nursing facilities. Patients have the same access to a physician as they would in an acute care hospital and the benefit of receiving rehabilitative care. The focus of an LTCH is to provide extensive clinical patient care while moving the patient toward a normal lifestyle. When compared to other post-acute services, the LTCH can better meet the patient’s clinical needs.
American Hospital Association. 2020. Long term care hospital PPS. Retrieved from https://www.aha.org/advocacy/long-term-care-pps
Home Health Agencies (HHA) play an extremely important part along the healthcare continuum. They provide nursing and therapy services within the patient’s home. Like all PACs, HHAs are required to submit assessments, in this case the Outcome Assessment Information Set (OASIS). Information within the OASIS helps determine the payment level and include data to track quality outcomes. Caring for patients with higher clinical needs and more service utilization will result in a higher reimbursement. For Medicare and Medicare Advantage plan beneficiaries there is “no cost sharing for home health services, except for a 20 percent coinsurance for medical equipment” (Castro, 2018, p. 221). Commercial plan coverage for home health services varies. According to Elflein (2019) most individuals receiving home care are over 65 years old. Additionally, beneficiaries are eligible for an unlimited number of episodes of home care if eligibility requirements are met (Castro, 2018). Considering the generous coverage, home care is very affordable to those who need it most.
Measuring quality for home health agencies is done using admission and discharge OASIS data comparison. The agency monitors its own data through internal benchmarking to ensure they are achieving quality care through improved patient function. The Centers for Medicare and Medicaid Services (CMS) also tracks OASIS data for every one of its beneficiaries to ensure proper utilization and improved outcomes. HHA can use external benchmarking through CMS to compare their quality scores with other HHAs.
Carecentrix. (2018, May 29). In-home care services to be covered by medicare advantage plans.
Castro, A.B. (2018). Principles of healthcare reimbursement (6th ed.). Chicago, IL: American Health Information Management Association
Elflein, J. (2019, July 11). Home care in the U.S.- Statistics & facts. Statista. https://www.statista.com/topics/4049/home-care-in-the-us/
Home Care Alliance. (n.d.). Who pays for home care? https://homecarealliance.org/locate-an-agency/consumer-resources/who-pays-for-home-care/
Data Sources. (n.d.). Home Health Compare. https://www.medicare.gov/HomeHealthCompare/Data/Data-Sources.html