Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
Medicare Beneficiary Access 
to Skilled Nursing Facilities 
2001 
JULY 2001 
OEI-02-01-00160  OFFICE OF INSPECTOR GENERAL 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to 
protect the integrity of the Department of Health and Human Services programs as well as the 
health and welfare of beneficiaries served by them. This statutory mission is carried out through 
a nationwide program of audits, investigations, inspections, sanctions, and fraud alerts. The 
Inspector General informs the Secretary of program and management problems and recommends 
legislative, regulatory, and operational approaches to correct them. 
Office of Evaluation and Inspections 
The Office of Evaluation and Inspections (OEI) is one of several components of the Office of 
Inspector General. It conducts short-term management and program evaluations (called 
inspections) that focus on issues of concern to the Department, the Congress, and the public. 
The inspection reports provide findings and recommendations on the efficiency, vulnerability, 
and effectiveness of departmental programs. 
OEI's New York regional office prepared this report under the direction of John I. Molnar, 
Regional Inspector General, and Renee C. Dunn, Deputy Regional Inspector General. Principal 
OEI staff included: 
REGION  HEADQUARTERS 
Jodi Nudelman, Project Leader
 Tricia Davis, Program Specialist

Vincent Greiber, Lead Analyst
 Brian Richie, Director, Technical Support Staff

Danielle Fletcher
 Linda Moscoe, Technical Support

Nicole Gillette

Thomas Purvis, Region IX

Thomas Zimmermann

.

To obtain copies of this report, please call the New York Regional Office at (212) 264-2000. 
Reports are also available on the World Wide Web at our home page address: 
http://www.hhs.gov/oig/oei  E X E C U T I V E  S U M M A R Y  
PURPOSE 
To assess the effects of the prospective payment system on access to skilled nursing 
facilities for Medicare beneficiaries. 
BACKGROUND 
The Balanced Budget Act (BBA) of 1997 changed reimbursement for skilled nursing 
care from a cost-based method to a prospective payment system (PPS) of fixed, 
predetermined rates. The prospective payment system was implemented in January 1999. 
In addition, the Balanced Budget Refinement Act increased certain payment rates under 
PPS that went into effect October 1, 2000. 
This report is a follow-up to two previous Office of Inspector General inspections, Early 
Effects of the Prospective Payment System on Access to Skilled Nursing Facilities, OEI-
02-99-00400 and Medicare Beneficiary Access to Skilled Nursing Facilities: 2000, OEI-
02-00-00330. Both reports found that most discharge planners are able to place Medicare 
patients in SNFs. However, about half of discharge planners believe that nursing homes 
are changing their admissions practices in response to PPS. 
We used several methods to address the inspection issues. We conducted a survey of a 
random sample of 208 hospital discharge planners that focused on beneficiary access to 
skilled nursing care. We also analyzed the Centers for Medicare and Medicaid Services 
Provider of Services File and the National Claims History File. 
FINDINGS 
Most Medicare beneficiaries continue to have access to skilled 
nursing facilities 
Little change in placing beneficiaries since increases to payment rates. About 73 
percent of discharge planners report that they are able to place all of their Medicare 
patients who need care in skilled nursing facilities. Another 20 percent are able to place 
all but 1 to 5 percent, and 7 percent are not able to place more than 5 percent. Discharge 
planners report that they have to contact an average of three facilities to place a Medicare 
patient. They explain that patients whom they are not able to place in a skilled 
i
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  nursing facility often remain in the hospital or go home either with or without home 
health care. 
Sufficient number of Medicare nursing home beds seems to be available.  Seventy-
five percent of discharge planners report that there are enough skilled nursing facility 
beds in their area for Medicare patients. Those who say there are not enough beds note 
that facilities are often full or that the bed supply in their area has not kept pace with the 
needs of a growing elderly population. Medicare data indicate that the number of skilled 
nursing facility beds nationwide increased by nearly 38 percent from 1997 to 2000. 
Patients with certain service needs experience delays 
Some discharge planners report delays in placing Medicare patients in skilled nursing 
facilities. Thirty-six percent say they experience delays sometimes, while 16 percent say 
they usually or always experience delays when placing beneficiaries in skilled nursing 
facilities. Seventy-six percent of discharge planners who report delays say that they are 
associated with certain medical conditions or service needs. They most commonly cite 
delays associated with patients who need IV antibiotics and/or expensive drugs, 
ventilator-dependent patients, and those who require dialysis. 
Over half of the discharge planners who report delays associated with medical conditions 
or service needs attribute these delays to PPS. Some explain IV therapy often requires 
expensive medications that are not adequately reimbursed for under PPS. In addition, 
some dialysis patients experience delays when transportation costs are not covered by 
Medicare. Lastly, ventilator and wound care patients are delayed because their needs are 
often labor intensive and require expensive medical supplies. 
CONCLUSION 
Similar to the findings of our two previous inspections, most Medicare beneficiaries 
continue to have access to skilled nursing facilities. At the same time, access to care does 
not appear to have changed as a result of increases to certain payment rates under the 
Balanced Budget Refinement Act of 1999. We encourage the Centers for Medicare and 
Medicaid Services to continue to monitor access to care and skilled nursing facilities 
responses to the payment system. 
ii
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  T A B L E   O F   C O N T E N T S  
PAGE

EXECUTIVE SUMMARY  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  i

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

FINDINGS

Most Medicare Beneficiaries Continue to Have Access to SNFs  ................... 5

Patients with Certain Service Needs Experience Delays .......................... 7

CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  9

APPENDICES 
A:  Recent OIG SNF Inspections ........................................ 10

B:  Confidence Intervals for Key Findings  ................................ 11

C:  Proportion of Beneficiaries Discharged to SNFs by Top DRGs  ............ 12

D:  Average Hospital Length of Stay by Top DRGs ......................... 13

iii
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  I N T R O D U C T I O N  
PURPOSE 
To assess the effects of the prospective payment system on access to skilled nursing 
facilities for Medicare beneficiaries. 
BACKGROUND 
This inspection re-examines the effects of the prospective payment system (PPS) on 
Medicare beneficiary access to skilled nursing facilities (SNFs). It is part of the Office of 
Inspector Generals (OIG) continuing commitment to safeguard skilled nursing care and 
to respond to ongoing concerns that the new payment system may adversely affect 
beneficiary access to SNFs. 
In 1999, the Centers for Medicare and Medicaid Services (CMS) asked the OIG to assess 
the effects of the prospective payment system for SNFs on access to care for Medicare 
beneficiaries. In response, the OIG completed two reports, Early Effects of the 
Prospective Payment System on Access to Skilled Nursing Facilities, OEI-02-99-00400 
and Medicare Beneficiary Access to Skilled Nursing Facilities: 2000, OEI-02-00-00330. 
Both reports found that most discharge planners are able to place Medicare patients in 
SNFs. However, about half of discharge planners believe that nursing homes are 
changing their admissions practices in response to PPS. 
In another report entitled Trends in the Assignment of Resource Utilization Groups by 
Skilled Nursing Facilities, OEI-02-01-00280, we examined the proportion of Medicare 
beneficiaries assigned to each of the Resource Utilization Groups (RUGs) in light of 
recent legislative changes to PPS. (See Appendix A.) 
Medicare Payments to SNFs 
Medicare Part A helps to pay for SNF care when a beneficiary meets certain conditions. 
These conditions include a requirement of daily skilled nursing or rehabilitation services, 
a prior three consecutive days stay in a hospital, admission to an SNF within a short 
period of time after leaving the hospital, treatment for the same condition that was treated 
in the hospital, and a medical professional certifying the need for daily skilled nursing or 
rehabilitation care. The number of SNF days provided under Medicare is limited to 100 
days per benefit period, with a co-payment required for days 21 through 100. After the 
Medicare 100 day SNF Part A benefit runs out, the Medicare Part B benefit continues to 
pay for physician services and other Part B-covered services. 
1
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  Between 1990 and 1998, expenditures for Medicare SNF services have increased, on 
average, 25 percent annually, reaching $13.6 billion in 1998. Between 1990 and 1997, 
the number of beneficiaries receiving SNF care more than doubled, rising from 638,000 
to 1.6 million. Medicares average payment per SNF day also more than doubled, from 
$98 in 1990 to $262 in 1998. At the same time, the number of days of care per SNF 
patient served dropped from 37 to 32.1  The latest data available show that SNF 
expenditures have decreased slightly to $12.2 billion in Fiscal Year 1999. 
SNF Prospective Payment 
In order to control escalating nursing home costs, Congress passed the Balanced Budget 
Act of 1997 that changed SNF reimbursement from a cost-based to a prospective 
payment system. Beginning with the first cost reporting period after July 1, 1998, SNFs 
are paid through prospective, case-mix adjusted per diem payments that cover routine, 
ancillary, and capital-related costs, including most items and services for which payment 
was previously made under Medicare Part B. The per diem payment is based on Fiscal 
Year 1995 Part A & B costs adjusted using the SNF market basket index, the case-mix 
from resident assessments, and geographical wage variations. The market basket index 
represents an inflation factor. The case-mix index takes into account that SNF residents 
require different levels of care. 
To determine the case-mix, SNFs are required to assign residents into 1 of 44 Resource 
Utilization Groups (RUGs). The RUGs are divided into seven major categories: special 
rehabilitation, extensive services, special care, clinically complex, impaired cognition, 
behavior problems, and reduced physical function. To determine the RUG, SNFs must 
fill out the Minimum Data Set 2.0 (MDS) assessment which is a standardized set of 
clinical and functioning status measures. Facilities must complete an assessment for each 
patient at scheduled intervals during his or her stay. 
In the Fall of 1999, Congress enacted the Balanced Budget Refinement Act (BBRA) in 
response to providers concerns that reductions in payments were too severe. The BBRA 
included a 4 percent across-the-board increase in payments to SNFs for Fiscal Years 
2001 and 2002 and a temporary 20 percent increase for 15 RUGs for patient conditions 
considered medically complex. These include all the RUGs in the clinically complex, 
special care, and extensive care categories as well as three RUGs in the special 
rehabilitation category. In addition, several costly non-therapy ancillary services, 
including certain ambulance services, prostheses, and chemotherapy drugs, were 
excluded from the prospective payment system and paid for separately. The BBRA 
changes went into effect on October 1, 2000. 
1 General Accounting Office, Skilled Nursing Facilities: Medicare Payment Changes Require Provider 
Adjustments But Maintain Access, 1999. 
2
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  In 2000, Congress further adjusted the payment rates under the Benefits Improvement 
and Protection Act (BIPA). The BIPA increased the inflation update to the full market 
basket in Fiscal Year 2001 and raised the nursing component of the RUGs by 16.6 
percent in an effort to improve PPS nursing staff ratios. Additionally, the BBRA 20 
percent increase to the three rehabilitation RUGs was spread across all 14 special 
rehabilitation RUGs as a 6.7 percent increase. The other RUGs increased in the BBRA 
maintained the 20 percent increase. These changes went into effect on April 1, 2001. 
Discharge Planners 
By definition, all Medicare Part A beneficiaries in SNFs are discharged from hospitals. 
Hospital discharge planners are responsible for coordinating the discharge of patients to 
SNF care and are therefore in a unique position to assess the effects of the prospective 
payment system on access to nursing home care. 
Federal regulations require all hospitals to offer discharge planning services. The goal of 
these services is to identify a patients post-hospital needs and ensure that he or she is 
discharged to a safe environment with the appropriate level of services. In most 
hospitals, the social work, case management, or utilization review department has 
primary responsibility for discharge planning. Patients can be placed in a variety of 
settings including SNFs, home health care, hospices, or intermediate care. 
Discharge planning staff generally follow a standard process. In a typical scenario, staff 
screen patients records within 24 hours of admission. They attempt to identify patients 
who will require discharge planning services, such as those who are 65 years and older 
and living alone or those with possibly life-threatening illnesses. They then conduct a 
psycho-social assessment and discuss the patients care plan with his or her nurses and 
physicians as well as utilization review staff, and other relevant interdisciplinary team 
members. Discharge planners also solicit the patients preferences and contact family 
members or other potential caregivers to get their input and cooperation. Based on this 
information, they attempt to place the patient in the most appropriate setting. 
Other Work on Access to Skilled Nursing Facilities 
In 1999, the General Accounting Office (GAO) released Skilled Nursing Facilities: 
Medicare Payment Changes Require Provider Adjustments But Maintain Access. The 
report generally concurs with the OIG reports discussed earlier. It found that Medicare 
beneficiaries ability to obtain care does not appear to have decreased since the 
implementation of PPS. However, about two-thirds of discharge planners reported that 
SNFs have become more reluctant to admit higher-cost patients, such as those requiring 
expensive drug treatment or infusion therapy. Many discharge planners further noted 
that facilities prefer to admit patients needing short-term rehabilitation. 
3
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  METHODOLOGY 
We used several methods to address the inspection issues. These methods replicate the 
approach used in the two prior OIG inspections on access to SNFs. 
Discharge Planner Survey 
We conducted a survey of hospital discharge planners that focused on beneficiary access 
to home health care. To do this, we selected a random sample of 225 acute care hospitals 
with 30 or more beds from the 50 States and the District of Columbia. We conducted 
interviews with 208 discharge planners or their designees within a 3 week period from 
April 2, 2001 to April 20, 2001. We achieved a 92 percent response rate. Note that this 
sample is the same sample of hospitals used in the OIG inspection, Medicare Beneficiary 
Access to Home Health Care: 2001, OEI-02-01-00180. 
Analysis of Medicare Data 
In addition, we analyzed Medicare data for beneficiaries who were discharged from a 
hospital to a SNF. Specifically, we analyzed the proportion of Medicare beneficiaries 
discharged to SNFs by key diagnosis related groups (DRGs) to determine the extent to 
which SNFs are admitting different types of patients. We also analyzed the length of 
hospital stays by key DRGs to examine whether patients are experiencing longer delays 
before entering SNFs. 
These analyses are based on data from the National Claims History File. We identified 
all beneficiaries who: 1) were discharged from a hospital between January 1, 2001 
through March 31, 2001, and; 2) had a SNF stay that started within 30 days of their 
hospital discharge. We then compared these data to the same data for the first quarters of 
1997, 1998, 1999, and 2000. In addition, we examined trends in the number of SNFs and 
the number of nursing home beds certified for Medicare based on data from the Provider 
of Services (POS) File. 
Limitations 
The data for the most recent quarter, January to March 2001, are not as complete as the 
other quarters of data. Additional and adjusted claims will be collected for this quarter 
that may alter these data. 
This inspection was conducted in accordance with the Quality Standards for 
Inspections issued by the Presidents Council on Integrity and Efficiency. 
4
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  F I N D I N G S
Most Medicare beneficiaries continue to have access to skilled
nursing facilities
Little change in placing beneficiaries since increases to payment rates
About 73 percent of discharge planners report that they are able to place all of their
Medicare patients who need care in skilled nursing facilities.  Another 20 percent are 
able to place all but 1 to 5 percent.  Seven percent are not able to place more than 5
percent.  (See Figure 1).  About 80 percent of discharge planners were able to place all of
their Medicare patients last year.  The differences between the estimates for this year and
last year, however, are not statistically significant.  Most discharge planners (86 percent)
also report no difference in the number of patients whom they cannot place since last year
when increases were made to certain payment rates under PPS.
Figure 1
Proportion of Discharge Planners Placing Patients in SNFs
Source: Discharge Planner Survey, 2001
Discharge planners report that they have to contact an average of three facilities to place
a Medicare patient.  They explain that patients whom they are not able to place in a SNF
often remain in the hospital or go home either with or without home health care. 
Medicare data support discharge planners experiences.  The data show that there are no
large changes in the types of Medicare beneficiaries being discharged to SNFs in the last
5 years.  A decrease in a diagnosis related group (DRG) may indicate that patients with
that condition are experiencing problems with access to care.  However, there are no
large decreases in the proportion of Medicare beneficiaries for the 10 most common
5
Medicare Beneficiary Access to SNFs 2001           OEI 02-01-00160 DRGs discharged to SNFs in any of the years between 1997 and 2001. The 10 most 
common DRGs are the same in each of the last 5 years and represent about 44 percent of 
all Medicare beneficiaries discharged to SNFs. (See Appendix C.) 
Two of these DRGs experienced small decreases that are greater than one percentage 
point. Specifically, respiratory infections and inflammations (DRG 79) and specific 
cerebrovascular disorders (DRG 14) decreased by 1.5 percentage points and 1.2 
percentage points, respectively, between 1997 and 2001. 
Another report issued by the OIG, Trends in the Assignment of Resource Utilization 
Groups by Skilled Nursing Facilities, OEI-02-01-00280, also found no large changes in 
the types of patients being admitted to SNFs in the last 2 years. Specifically, the report 
shows that the proportion of Medicare beneficiaries assigned to each of the Resource 
Utilization Groups (RUGs) at admission has remained about the same from 1999 to 2001. 
Sufficient number of Medicare nursing home beds seems to be available 
Seventy-five percent of discharge planners report that there are enough SNF beds in their 
area for Medicare patients. Those who say there are not enough beds explain that 
facilities are often full or that the bed supply in their area has not kept pace with the 
needs of a growing elderly population. A similar proportion of discharge planners in 
urban and rural hospitals report that the bed supply for Medicare patients is sufficient in 
their area. In addition, most (86 percent) report that the number of Medicare beds in their 
area has stayed the same or increased since last year. 
Medicare data indicate that the number of Medicare SNF beds continues to increase. As 
shown in Figure 2, the number of Medicare beds nationwide increased by nearly 38 
percent between 1997 and 2000. This increase was largely due to a rise in the number of 
dually certified beds that are available for either Medicare or Medicaid patients. The 
total number of certified nursing home beds and the number of SNFs nationwide 
increased only slightly during this time period. 
Figure 2

Total Number of SNFs and Nursing Home Beds

1997  1998  1999  2000  Percent Change 
1997-2000 
Number of SNFs  14,772  15,025  14,911  14,839  0.5% 
Total Medicare Beds  681,456  722,278  836,701  939,356  37.8% 
Total Certified Beds*  1,528,061  1,556,495  1,556,569  1,560,661  2.1% 
* Medicare and Medicaid beds  Source: Provider of Services File 
6
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  Patients with certain service needs experience delays 
Some discharge planners report delays in placing Medicare patients in SNFs.2  Thirty-six 
percent say they experience delays sometimes, while 16 percent say they usually or 
always experience delays when placing beneficiaries in SNFs. A similar proportion of 
discharge planners reported placement delays last year. 
Most discharge planners (76 percent) who report delays say that they are associated with 
certain medical conditions or service needs. They most commonly cite delays associated 
with patients who need IV antibiotics and/or expensive drugs, ventilator-dependent 
patients, and those who require dialysis. (See Figure 3.) Discharge planners reported 
similar conditions associated with delays last year. These are also the same medical 
conditions and service needs discharge planners describe for beneficiaries whom they 
cannot place. 
Figure 3

Responses of Discharge Planners who Report that Delays are Associated 

with Medical Conditions/ Service Needs 

Medical Condition/ Service Need  Percent 
(n=142) 
IV Antibiotics/ Expensive Drugs
 36% 
Ventilator
 28% 
ESRD/ Dialysis
 25% 
Behavior Problems/ Alzheimers
 23% 
Wound Care/ Decubitus Ulcers  22% 
Infectious Disease/ Isolation Needs  22% 
Note: Categories are not mutually exclusive.  Source: Discharge Planner Survey, 2001 
A few discharge planners also note delays that are associated with other types of patients. 
Some mention delays placing patients with tracheotomies or respiratory failure and 
patients requiring parenteral or enteral feedings. Others cite patients with specialized 
equipment needs such as those with weight problems. A few cite delays associated with 
patients who have mental health issues, chemotherapy needs, and HIV/AIDS. They 
explain that these patients may be delayed because they require expensive medications or 
more supervision than other patients. 
2 Delays in placement occur when a patient has been cleared for discharge by the physician but no SNF bed 
has been secured. 
7
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  Medicare data, however, show no increases in the average hospital length of stay for 
Medicare beneficiaries discharged to SNFs. In fact, the average length of stay slightly 
decreased for all but 1 of the 10 most common DRGs between 1997 and 2001. 
Specifically, the average length of stay for each of these DRGs decreased by less than 
one day. (See Appendix D.) 
Over half of discharge planners who report that delays are associated with medical 
conditions or service needs attribute these delays to PPS. They comment that delays are 
due to low reimbursement and to staffing issues under PPS. Some explain IV therapy 
often requires expensive medications that are not adequately reimbursed for under PPS. 
In addition, some dialysis patients experience delays when transportation costs are not 
covered by Medicare.3  Lastly, ventilator and wound care patients also experience delays 
because their needs are often labor intensive and require expensive medical supplies. 
Discharge planners mention several other factors that affect the placement process. 
About half of all discharge planners report that SNFs have changed their admissions 
practices since last year. They most commonly say that SNFs request more information 
about patients and more frequently conduct on-site visits prior to admission. Some 
discharge planners also cite family issues. They mention that family members or 
caregivers sometimes delay the process to consider different placement options or 
because they want to wait for a bed in a particular nursing home. Others cite issues that 
are related to physicians. A few note that physicians may prefer to wait for a bed in a 
hospital-based SNF so that they can track the patient more closely. 
3 The BBRA allows ambulance transport to be paid for under Part B, although some discharge planners 
suggest that transportation remains a problem. 
8
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  C O N C L U S I O N  
Similar to the findings of our two previous inspections, most Medicare beneficiaries 
continue to have access to skilled nursing facilities. At the same time, access to care does 
not appear to have changed as a result of increases to certain payment rates under the 
Balanced Budget Refinement Act of 1999. We encourage the Centers for Medicare and 
Medicaid Services to continue to monitor access to care and skilled nursing facilities 
responses to the payment system. 
9
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  APPENDIX A 
Recent Office of Inspector General
Skilled Nursing Facility Inspections 
Office of Inspector General, U.S. Department of Health and Human Services, Trends in the 
Assignment of Resource Utilization Groups by Skilled Nursing Facilities, OEI-02-01-00280, 
July 2001. 
Office of Inspector General, U.S. Department of Health and Human Services, Nursing Home 
Resident Assessment Resource Utilization Groups, OEI-02-99-00041, January 2001. 
Office of Inspector General, U.S. Department of Health and Human Services, Medicare 
Beneficiary Access to Skilled Nursing Facilities: 2000, OEI-02-00-00330, September 2000. 
Office of Inspector General, U.S. Department of Health and Human Services Early Effects of 
the Prospective Payment System on Access to Skilled Nursing Facilities: Nursing Home 
Administrators Perspective, OEI-02-99-00401, October 1999. 
Office of Inspector General, U.S. Department of Health and Human Services Early Effects of 
the Prospective Payment System on Access to Skilled Nursing Facilities, OEI-02-99-00400, 
August 1999. 
10
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  APPENDIX B 
Confidence Intervals for Key Findings 
We calculated confidence intervals for key findings for discharge planners. The point 
estimate and 95% confidence intervals are given for each of the following: 
KEY FINDINGS  n  POINT  CONFIDENCE 
ESTIMATE  INTERVAL 
Seventy-three percent of discharge planners report 
that under PPS they are able to place their Medicare  208  73%  6.1% 
patients in skilled nursing facilities. 
Most discharge planners (86 percent) also report no 
difference in the number of patients who they cannot 
195  86%  4.8% 
place since last year when several changes were 
made to increase payments to PPS. 
Seventy-five percent of discharge planners report 
that there are enough SNF beds in their area for  208  75%  5.9% 
Medicare patients. 
Thirty-six percent say they experience delays 
208  36%  5.9% 
sometimes. 
Most discharge planners (76 percent) who report 
delays say that they are associated with certain  186  76%  6.1% 
medical conditions or service needs. 
Over half of the discharge planners who report 
delays associated with medical conditions or service  142  59%  8.1% 
needs attribute these delays to PPS. 
About half of discharge planners report that SNFs 
have changed their admissions practices since last  208  53%  6.8% 
year. 
11
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  APPENDIX C 
Proportion of Beneficiaries Discharged to SNFs

by Top Diagnosis Related Groups (DRGs)
*

1997  1998  1999  2000  2001  1997-2001

Initial Hospital DRG  Difference 
DRG 079- Respiratory infections 
4.2%  3.4%  3.1%  2.8%  2.7%  -1.5 
and inflammations 
DRG 014- Specific 
6.7  6.0  6.0  5.6  5.5 
cerebrovascular disorders  -1.2 
DRG 210- Hip and femur 
5.2  4.6  4.7  4.5  4.3  -0.9 
procedures except major joint 
DRG 416- Septicemia  2.7  2.5  2.3  2.2  2.2  -0.5 
DRG 209- Major joint and limb 
8.5  8.2  8.4  8.0  8.5  0.0 
reattachment procedures 
DRG 088- Chronic obstructive 
2.7  3.2  3.3  3.1  2.8  0.0 
pulmonary disease 
DRG 089- Simple pneumonia 
6.5  8.0  8.0  8.2  6.6  0.1 
and pleurisy 
DRG 127- Heart failure and 
4.8  5.0  4.9  4.9  5.1  0.2 
shock 
DRG 296- Nutritional and misc. 
2.6  2.6  2.7  2.8  2.9  0.3 
metabolic disorders 
DRG 320- Kidney and urinary 
2.1  2.2  2.2  2.3  2.5  0.5 
tract infections 
Source: National Claims History File 
*Note: Differences may be due to rounding. 
12
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160  APPENDIX D 
Average Hospital Lengths of Stay For Beneficiaries
Discharged to SNFs by Top Diagnosis Related Groups
(DRGs)
* 
1997  1998  1999  2000  2001  1997-2001

Initial Hospital DRG  Days  Days  Days  Days  Days  Difference 
DRG 014- Specific 
9.7  9.4  9.2  9.2  9.1  -0.6 
cerebrovascular disorders 
DRG 089- Simple pneumonia and 
9.0  8.7  8.6  8.7  8.4  -0.6 
pleurisy 
DRG 296- Nutritional and misc. 
8.6  8.3  8.2  8.1  8.0  -0.5 
metabolic disorders 
DRG 320- Kidney and urinary 
8.2  7.8  7.8  7.8  7.7  -0.5 
tract infections 
DRG 127- Heart failure and shock  9.2  8.8  8.8  8.8  8.7  -0.4 
DRG 088- Chronic obstructive 
8.8  8.5  8.4  8.5  8.4  -0.4 
pulmonary disease 
DRG 209- Major joint and limb 
6.7  6.4  6.4  6.5  6.3  -0.3 
reattachment procedures 
DRG 210- Hip and femur 
8.1  7.8  7.8  7.8  7.8  -0.2 
procedures except major joint 
DRG 079- Respiratory infections 
11.2  11.1  11.1  11.3  11.1  0.0 
and inflammations 
DRG 416- Septicemia  10.5  10.3  10.4  10.9  10.7  0.2 
Source: National Claims History File 
*Note: Differences may be due to rounding. 
13
Medicare Beneficiary Access to SNFs 2001   OEI 02-01-00160