Learning Resources
Required Readings
Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). New York, NY: Springer Publishing.
- Chapter 15, “Health Policy and Future Trends” (pp. 447–457)
American Health Care Association. (2019). SNF value-based purchasing (SNF VBP). Retrieved from
Document: Week 6 Sunnyside Nursing Home Revenue Plan (Excel document)
Required Media
Laureate Education, Inc. (Executive Producer). (2018). Calculating the financial impact of Medicare changes [Video file]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 12 minutes.
Discussion: Healthcare Policy and Financing in the U.S.
Value-based purchasing and pay-for-performance may continue to affect health policy, future reimbursement, and care-delivery trends in the United States. Outpatient services and post-acute services have recently come under the scrutiny of the Centers for Medicare and Medicaid Services (CMS) to ensure quality of care to ultimately control costs.
Skilled Nursing Facility (SNF) Value-Based Purchasing went into effect on October 1, 2018, for the fiscal year 2019. Nursing homes that offer short-term rehabilitation and get reimbursed by Medicare Part A fall into this category. Specifically, SNFs will have a reduction in Medicare reimbursement based on rehospitalization rates. CMS will look back 2 years and will compare the rehospitalization rate from 2016 to 2018 for year one. Low-performing SNFs can potentially lose 2% on their Medicare fee-for-service (FFS) reimbursement.
Sunnyside Nursing Home, from Week 4, continues to have a 35% readmission rate, so the leadership is anticipating they will be affected by the Medicare discount. Medicare may also consider a reduction in hospice reimbursement as well, potentially 1.8%. Based on these expected changes and current data, you will make a recommendation regarding the future census planning at Sunnyside.
To Prepare:
- Review the Sunnyside Nursing Home Revenue Plan.
- Familiarize yourself with the information found on the Overview of Terms tab.
- Review the Sunnyside Nursing Home CMS Discount Revenue media piece in the resources to assist you in calculating the few missing cells in the Revenue Plan.
- Study the completed Revenue Plan tab to see the impact of the Medicare changes.
- The AHCA NJ tab lists the projections for long-term care for New Jersey, where Sunnyside is located. Review the information, especially in the 85+-year-old column to see the impact, if any, on nursing home demand in New Jersey.
- The American Health Care Association (AHCA) website has several resources to guide healthcare planning in the United States: Download and analyze the Long-Term Care (LTC) Patient Projections report for your state. Look for your state to view the impact of the aging population. Pay specific attention to the 85+ trend.
- Complete the remaining calculations in the Sunnyside Nursing Home Revenue Plan.
- Based on the information in the report from AHCA and the spreadsheet, what recommendation would you make regarding the future census planning at Sunnyside?
By Day 4
Post a comprehensive response to the following:
- What are some of the future issues and concerns related to healthcare financing in the United States?
- How might healthcare policy inform financing of healthcare, and what might that mean for the quality of health?
- How will value-based purchasing affect healthcare providers? Review the information in the Sunnyside Case Study to guide this response. How can a healthcare provider ensure viability in the new value-based paradigm?
- Would you consider new technologies for Sunnyside to employ to reduce readmissions?
By Day 6
Respond to at least two of your colleagues by suggesting at least one way that a SNF can reduce rehospitalizations from SNF and/or how a SNF can continue to be successful as new regulations reduce reimbursement without negatively impacting quality patient care.
Expert Solution Preview
Future issues and concerns related to healthcare financing in the United States include rising healthcare costs, an aging population, unequal access to healthcare, and the need for innovative funding models to support healthcare delivery. Healthcare policy can inform financing of healthcare by setting guidelines and regulations for reimbursement, promoting preventive care and reducing healthcare costs, and supporting innovative funding models. Value-based purchasing will affect healthcare providers by incentivizing high-quality care to improve patient outcomes and reducing costs. To ensure viability in the new value-based paradigm, healthcare providers should focus on quality improvement, patient satisfaction, and reducing readmissions. Sunnyside Nursing Home can consider new technologies such as remote patient monitoring and telemedicine to reduce readmissions and enhance patient care.
