Changes in the nursing facility-hospital interface after the prospective payment system: the effects on patients with infections in the post-acute care setting.

Abstract

The purpose of the article is to discuss the impact of Center for Medicare and Medicaid Services (CMS) new prospective payment system (PPS) on the flow of patients between hospitals and nursing homes, with a particular focus on how patients with infections are likely to be affected. The first section describes Medicare’s relationship to skilled nursing facilities (SNFs). The second describes the revised reimbursement system, known as Resource Utilization Groups (RUGs), and the third section describes the changes in provider responses given the altered incentives around patient flows, created through use of the RUGs. The final section examines how these changes might affect the flow of residents with infections, particularly those that are resistant to antimicrobial agents.