Current law directs CMS to make reductions of up to 2 percent to certain SNFs' payments to incentivize them to improve care, but does not address additional reductions. GAO estimated that in 2018 Medicare spent over $5 billion on critical incidents that CMS defines as potentially preventable-which are mostly about 377,000 hospital readmissions occurring within 30 days of the SNF admission.
This limits the ability of beneficiaries to make informed choices among SNFs when choosing a facility. For example, GAO found that average RN staffing hours decreased about 40 percent on weekends, but CMS does not directly report this information. Percent of Skilled Nursing Facilities (SNFs) That Met Registered (RN) Nurse Staffing Requirement or Measures, 2019ĬMS reports certain key staffing information-such as RN overall staffing hours-on its Care Compare website, but does not report other important information. SNFs are not subject to these quality thresholds for ratings or as requirements, but many stakeholders have recommended that they be used as SNF staffing thresholds. Further, about one-quarter of SNFs frequently met staffing thresholds for minimum RN and total nurse staffing that a CMS staffing study identified as needed to avoid quality problems. For example, about half of SNFs frequently met Centers for Medicare & Medicaid Services (CMS) case-mix measures-hours worked per resident that vary based on the medical needs of each SNF's residents-that CMS uses to set SNF staffing ratings. Fewer SNFs frequently met two other staffing measures that specify different numbers of nursing hours per resident per day. GAO's analysis of 2019 staffing data found that almost all SNFs frequently met a federal requirement for a registered nurse (RN) on site for 8 hours per day. Medicare covers short-term care for residents in about 15,500 skilled nursing facilities (SNF) after a hospital stay.
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