Posthospital Care

In response to a congressional request, GAO provided information concerning access to posthospital care for Medicare beneficiaries.

GAO found that 3 percent of discharge planners reported no problems in placing patients in skilled nursing facilities (SNF) and 14 percent reported no problems in home health care placements. According to discharge planners: (1) the most important barrier to the placement of Medicare beneficiaries in both SNF and home health care is Medicare program rules and regulations; (2) the availability of skilled nursing beds is next in importance as an important barrier to SNF placement; (3) the access to posthospital care for Medicare patients is more problematic now than it was in 1982; (4) the percentage of patients waiting in hospitals for appropriate posthospital placement has increased; and (5) the implementation of the Medicare prospective payment system and the incentive it gives hospitals to discharge patients as soon as is medically appropriate is a major factor in making the placement of Medicare patients more difficult. GAO also found that: (1) discharge planners in the northeast, south, and east north central regions are more likely to report increases in the percentage of patients awaiting posthospital placement than their peers in the west north central and Pacific regions; and (2) the proportion of discharge planners who cited each barrier as an important factor generally increased with population density.