There are times when patients who are residents of skilled nursing facilities elect hospice and stay on in the facility even though no longer technically under the care of the SNF. Most often, these patients are receiving skilled nursing services under the Medicaid benefit. Once the beneficiary elects hospice and selects a provider contracted with the SNF, the hospice assumes responsibility for patient care. The patient is discharged by the SNF and admitted by the hospice on the same day. As care proceeds, the hospice bills the Medicaid program for the patient’s room and board and also bills Medicare for hospice services embodied in the days of care it provides. The hospice then reimburses the SNF for the residential services that it provides. In this scenario, the place of service is the SNF (or nursing home) even though the provider of services is the hospice.
It is also possible for a hospice patient to receive temporary respite services in a SNF, once again based on a contractual arrangement between the hospice and the SNF under which the hospice reimburses the SNF for up to five days of room and board. In this scenario the hospice also bills for the patient’s respite services and is obligated to reimburse the facility for the residential care provided.
In some critical patient situations, they may also receive general inpatient care in a SNF due to a need for more intensive monitoring with frequent medication changes or nursing interventions that could be required on a 24 hour basis. Once again, in this situation, the hospice is responsible for providing care and for reimbursing the facility for the patient's room and board.
This metric is found in one location in the Excel Health Hospice Solution; the Facilities page in the SNFs tab of the main table.
Comparison with other SNF/Hospice Patient counts
There is no single scenario that leads to a patient receiving hospice care at a skilled nursing facility. Any hospice patient residing in a SNF would be categorized as Hospice at the SNF.
As a result, the two metrics in the red box in the image above require some clarification. At first glance, it might seem that the Hospice Care at the SNF is a subset of "All Hospice Patients." Some details regarding how we calculate these metrics will help:
All Patients entering Hospice w/in 30 days of D/C
- Claims used - We calculate this from both the SNF claim and the Hospice claim, comparing discharge/admit dates.
- Reference Period - these two claims only produce a "hit" if the admission occurs within 30 days of the initial SNF discharge
- Sequence - To be included in this metric, the SNF Discharge must precede the Hospice Admission.
Hospice Care at the SNF
- Summary - We look for SNF discharge/HOS Admission claims that fall on the same day, OR, HOS bene claims with Q code Q5004 at any time during or after a SNF stay.
- Claims used - No SNF claim is necessary, so this count would not be in the other column. For example: this covers a patient receiving Hospice care at a SNF who had not received prior SNF care.
- Reference Period/Sequence - The same day requirement will eliminate many patient counts found in the first column.
In summary, some patients can be counted in each column, some might be only counted in the first column, and some might be counted only in the second column.