What Does SNF Mean? It's Secret Code For Nursing Homes With Nurses.

Here's how Medicare works.  Grandma gets admitted to the hospital for an emphysema attack.   Grandma stays for a few days  getting medical therapies.   Every day grandma is hospitalized she gets weaker and weaker and weaker.  It has now been four days and grandma is ready to go back home to smoke, but she's too weak to hold her own cigarette.  So where is grandma supposed to go?

It used to be that grandma went to stay with her family until she was well enough to go home.  Now we have the Medicare National Bank picking up the tab.  They'll pay up to 100 days a year of room and board and therapies at a nursing home if grandma has at least a three midnight hospital admission in the prior thirty days.

They call it a skilled nursing facility, often referred to as a SNF, sniff or nursing home.   How convenient.  It's a nursing home;  A place with nurses.  In fact, they're so proud they have skilled nurses, they put that right in the beginning of the title.   I find it odd that Medicare would differentiate between nursing homes with skilled nurses and those with just nurses.  I don't know about you, but if I'm going to a nursing home, I want my nurses to show up with my dinner tray and a skill set the size of Texas.

Tell a patient they're going to a nursing home after hospital discharge and they'll likely refuse.  But, have social workers come in and tell them that Medicare will pay 100% of all charges for up to 100 days of rehab and we usually families calling non stop to convince granny to get her free room and board.  For that small subset of patients who adamantly refuse to go to a SNF, they cannot be forced to go if they have the capacity to make their own medical decisions.  So quit telling them they have no choice. 

This is pretty much the truth however you try and slice  it up to serve to the American people.   I'd say probably 90% of my patients don't need rehab.  They need time.  Oh yeah.  And they need a relative to step up to the plate and be there for them.  But no, we have Medicare, the source of all that is free and great and wonderful.  It's the perfect family out.

Unfortunately, things are changing.  Medicare simply can't continue to pay for what it has in the past.  Unless you're a physician assistant who doesn't understand what SNF really is:  Medicare funded nursing home tax payer theft.
Physician Assistant:  Hello.  I have a 600 pound woman I'd like to transfer in to you guys.  She's been here at our nursing home  for just over 60 days getting Es En Ef.
Happy's Partner:  Es En Ef?  You mean she's a nursing home patient?
Physician Assistant:  No.  She's here getting Es En Ef.
Happy's Partner:  What do you mean she's getting Es En Ef?  She's 600 pounds.  How much Es En Ef can you do on someone who's 600 pounds.
Physician Assistant:  I don't know.  The chart says she's getting Es En Ef.
Happy's Partner:  Sounds like you have yourself a nursing home patient.
There's really not a fine line between SNF and nursing home.  They are pretty much the same thing.  It's just a matter of who's going to pay for it.   You see, Medicare will pay for the physical, occupational, speech or specialized nursing care if you call it SNF and the patient has at least a three midnight hospital stay in the prior 30 days in their benefit period.   Medicare won't pay for it if you don't.  As a hospitalist, I see how this SNF game is played every day, day after day, year after year, month after month.  It has the opportunity to turn honest doctors into criminals.
Expert Chart Reviewer: Your patient doesn't qualify for inpatient status so they won't be able to go to Sniff.  But, my book of criteria says that if you order Q 4 hour neuro checks and give them some IV blood pressure medication, they'll meet inpatient criteria,  which they need to qualify for skilled nursing.
Welcome the the real world practice of Medicare medicine where it's not about ordering things to get patients better.  It's about ordering things to get someone else to pay it.   Now that my snark filled post is over, feel free to head on over to the official Medicare publication regarding SNF benefits. 

Some of this post is for entertainment purposes only and likely contains humor only understood by those in a health care profession. Read at your own risk. 

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