With more beneficiaries enrolling in Medicare Advantage, post-acute providers are suddenly finding themselves struggling to survive. Previously, most post-acute facilities billed only Medicare and Medicaid. However, they are increasingly having to deal multiple managed care plans — all of which pay at different rates and in different ways — due to state-specific Medicare Advantage requirements. This additional administrative burden is proving costly for these facilities, which have neither the experience nor the resources to deal with private payers in the same way hospitals and physicians do. As a result, the number of post-acute facilities has been declining as more of them are unable to handle the variability that comes with these new requirements.
During the Society of Hospital Medicine's 2013 annual meeting, hospitalists and hospital administrators discussed the need for hospitalists to play a bigger role both inside and outside the traditional hospital setting. “As part of health care's new cost containment, hospitalists will have to take the lead in smoothing out clinical variations, working to define consensus around best practices and making sure colleagues comply,” reported Today's Hospitalist. Presenters emphasized the need for hospitalists to prepare to work in post-discharge care settings such as skilled nursing facilities (SNFs), remarking that they are the most qualified to ensure seamless continuity of care between the hospital and these post-acute settings.
As hospitalists are being called on to expand their roles and responsibilities, U.S. News & World Report describes how healthcare reform is driving a shift to new staffing models in hospitals across the country. Coupled with the looming physician shortage, hospital administrators are moving away from employing once-popular physician specialists (radiologists, cardiologists, etc.) and instead looking towards hiring more primary care providers, emergency physicians and hospitalists. The article attributes the migration from fee-for-service to pay-for-performance reimbursements as one of the many reasons the staff of the “hospital of the future” will look very different from the hospital of today.