Medicaid Bed-Hold Policy and Medicare Skilled Nursing Facility Rehospitalizations

Analysis of the effect of Medicaid bed-hold policies on the 30-day rehospitalization of Medicare postacute skilled nursing facility (SNF) residents found a positive relationship between Medicaid bed-hold payment and 30-day SNF rehospitalization.

State bed-hold policies pay nursing homes to reserve beds for acutely hospitalized Medicaid nursing home residents, and the profit associated with bed-hold can be greater than the profit associated with continued care in the nursing home. The authors first identified Medicare discharges to nursing homes for each year 2000-2005. They then examined the pre-post differences in Medicare rehospitalizations for states that changed their Medicaid bed-hold policies versus states that did not, to determine whether patients discharged from a Medicare hospital to an SNF were rehospitalized within 30 days.

Key Findings:

  • Of first-time SNF admissions, 19.4 percent were rehospitalized within 30 days.
  • There was an increase in SNF rehospitalizations over time regardless of whether states had a bed-hold policy.
  • The rehospitalization rate for all years of the study was 5 to10 percent greater in states with a bed-hold policy than states without.

The authors argue that Medicaid bed-hold is an outdated policy; loss of a bed due to hospitalization is much less likely than it was 30 years ago. They tentatively recommend better enforcement of minimum occupancy requirements for nursing homes, but acknowledge that might not effectively decrease unnecessary hospitalizations.