Does Insurance Source Make a Difference In Meeting Rehabilitation Goals in Skilled Nursing Facilities?
thesisposted on 21.10.2015, 00:00 by Samson Barasa
Introduction The objective of this study was to determine whether there was an association between attainment of the Skilled Nursing Facility (SNF) goals and the payer source. Three insurance sources (Medicare, County contracts and Commercial insurances) were evaluated across 3 urban SNFs. Because each insurance source had different provider regulations, we investigated the potential impact of these differences on rehabilitation outcomes. Method We conducted a retrospective study of 234 patients admitted in three SNFs. Information collected included baseline characteristics (age, gender, etc.) as well as whether physical therapy, wound care and intravenous antibiotics goals were achieved. An “all or none” attainment of SNF goals analysis was measured using the Poisson logistic regression adjusting for age, gender, diabetes mellitus, anemia, infections and grooming as the baseline functional status at SNF admission. Results The mean ages of Medicare, Commercial insurance and County Contract patients were 73, 66 and 47 years old and the median SNF care length of stay was 52, 37 and 23 days respectively. When compared to Medicare, Commercial insurance patients [RR 2.51 (1.33 – 4.73)] were more likely to achieve their physical therapy goals, whereas County contract patients showed no difference in attaining physical therapy goals when compared to Medicare patients. Subset analyses revealed that older patients (p = 0.02), diabetics (p=0.03), patients with infections (p=0.03), those with a low functional status (p=0.03) and females (p=0.02) were less likely to attain predicted rehabilitation goals. Conclusion Commercial insurance patients are more likely to attain SNF care goals compared to Medicare patients. This study indicates that factors such as age, gender and the baseline functional status, in addition to diabetes mellitus and infections influence attainment of SNF care goals. Also noted is the week-to-week threat of Commercial insurance discontinuation if no rehabilitation progress is made, thus suggesting that time limitations for recovery specified by an insurer may be a motivating force for accelerating the recovery process.