Skilled Nursing Facilities: Available Data Show Average Nursing Staff Time Changed Little after Medicare Payment Increase Page: 4 of 36
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Accountability * Integrity * Reliability
United States General Accounting Office
Washington, DC 20548
November 13, 2002
The Honorable Max Baucus
The Honorable Charles E. Grassley
Ranking Minority Member
Committee on Finance
United States Senate
The Honorable William M. Thomas
The Honorable Charles B. Rangel
Ranking Minority Member
Committee on Ways and Means
House of Representatives
The nation's 15,000 skilled nursing facilities (SNF) play an essential role in
our health care system, providing Medicare-covered skilled nursing and
rehabilitative care each year for 1.4 million Medicare patients who have
recently been discharged from acute care hospitals. In recent years, many
analysts and other observers, including members of the Congress, have
expressed concern about the level of nursing staff in SNFs and the impact
of inadequate staffing on the quality of care. In 2000, the Congress
responded to these concerns with a temporary increase in Medicare
payment intended to encourage SNFs to increase their nursing staff.
Medicare pays SNFs through a prospective payment system (PPS) in
which they receive a fixed amount for each day that a patient receives
care. This daily payment rate varies according to a patient's expected
needs for care, and is the sum of nursing, therapy, and routine cost
components.' The Congress, through the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000 (BIPA),2 increased the
nursing component of the PPS SNF rate by 16.66 percent, effective April 1,
2001. This raised the overall SNF payment rates by 4 to 12 percent,
'The nursing component includes costs related not only to nursing but to medical social
services and nontherapy ancillary services, such as drugs, laboratory tests, and imaging.
The therapy component includes costs related to occupational, physical, and speech
therapy. The routine cost component includes costs for capital, maintenance, and food.
2Pub. L. No. 106-554, App. F, 312(a), 114 Stat. 2763, 2763A-498.
GAO-03-176 Nursing Staff in Skilled Nursing Facilities
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United States. General Accounting Office. Skilled Nursing Facilities: Available Data Show Average Nursing Staff Time Changed Little after Medicare Payment Increase, report, November 13, 2002; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc292979/m1/4/: accessed January 18, 2019), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.