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The Latest Research, Commentary, And News From Health Affairs

Tuesday, May 11, 2021

Dear John,

While skilled nursing facilities provide necessary care, there remain
questions about their costliness and efficiency.

Shortening Skilled Nursing Facility Stays

Care in skilled nursing facilities is a critical health care service for
many, but it also accounts for significant spending in Medicare and is
thought to be a major source of wasteful health care spending.

In fee-for-service Medicare, cost sharing applies to patients' care in
skilled nursing facilities after the twentieth day of residence. This
prompts a spike in discharges from facilities at that time. But does
cutting short these skilled nursing facility stays at day 20 negatively
impact patient health?

Brian McGarry and coauthors aimed to answer this question in a paper
they published in the May issue. They studied the extent to which
skilled nursing facility discharges accelerated by Medicare cost sharing
are safe
.

McGarry and coauthors found no clear evidence that those who are
discharged from a skilled nursing facility to home-based care face
increased risk of death, hospitalization for fall-related injuries, or
all-cause hospitalizations.

These findings suggest there are opportunities for more efficient
post-acute care delivery than keeping patients in facilities for long
periods of time.   

Coauthor J. Michael McWilliams will appear on A Health Podyssey

podcast later this month to discuss this research.

For more content like this, visit the Age-Friendly Health
content on our website.

Today on Health Affairs Blog, Katie Keith unpacks the Department of
Health and Human Services' interpretation of Section 1557
,
the Affordable Care Act's primary nondiscrimination provision, as
protection against discrimination based on sexual orientation and gender
identity.

Also, Hema Pingali and coauthors argue that aninterdisciplinary approach
to home-based primary care
,
supported by sustainable funding models, holds promise to take
personalized care to the next level for these patients, both during the
pandemic and beyond. This post is the first in an occasional series on
providing care for people with complex health and social needs
.

Elevating Voices: Asian American and Pacific Islander American Heritage
Month: In the March 2020 theme issue, The Affordable Care Act (ACA)
Turns 10, Aparna Soni and coauthors reviewed forty-three studies
examining the effects of the ACA. They found growing evidence that the
ACA has improved health outcomes

through insurance expansions for nonelderly adults.

Your Daily Digest

Outcomes After Shortened Skilled Nursing Facility Stays Suggest
Potential For Improving Postacute Care Efficiency

Brian E. McGarry, David C. Grabowski, Lin Ding, and J. Michael
McWilliams

HHS Will Enforce Section 1557 To Protect LGBTQ People From
Discrimination

Katie Keith

To Improve Care For Patients With Complex Needs, Expand Home Visits

Hema Pingali, Russell S. Phillips, and Dhruva Kothari

How Have ACA Insurance Expansions Affected Health Outcomes? Findings
From The Literature

Aparna Soni, Laura R. Wherry, and Kosali I. Simon

Podcast: Breaking Down How Pharmacy Deserts And Access Relate To Health
Equity

Alan Weil and Jenny Guadamuz

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Breaking Down How Pharmacy Deserts And Access Relate To Health Equity

Listen to Health Affairs Editor-in-Chief Alan Weil interview Jenny
Guadamuz from the University of Southern California School of Pharmacy
on pharmacy access and closures.

Listen Here

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