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Research Letter
May 28, 2019

Association Between High Discharge Rates of Vulnerable Patients and Skilled Nursing Facility Copayments

Author Affiliations
  • 1Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
  • 3Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 4Department of Public Health Sciences, University of Chicago, Illinois
  • 5Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
JAMA Intern Med. Published online May 28, 2019. doi:10.1001/jamainternmed.2019.1209

Medicare pays for 100% of postacute care provided by skilled nursing facilities (SNFs) during the first 20 days within a benefit period. However, on the 21st day, most patients become responsible for a daily copayment of more than $150.1 This copayment may present a significant financial burden for some patients—particularly those with limited economic means—and motivate them to discharge from SNFs on the 20th day of care based on their financial resources rather than their recovery status. Skilled nursing facilities may also prematurely discharge some patients to avoid the risk of accruing bad debt from partially uncompensated postacute care. However, it is not known whether patterns of SNF discharge are associated with this change in Medicare payment responsibility on day 20.

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