What is an ‘improvement standard?’

August 21, 2013

YoungGirlOldWoman-03

A familiar image. What do you see when you first glance at it? An older woman? A younger woman? Can you see both?

Much of the language being used to define standards for care reminds me of this image. There has been a lot of discussion about an ‘improvement standard’ in the health care arena. The notion is that providers may not cover care if a patient is not expected to have long-term improvement in  their medical condition. Some law suits have tackled this issue, especially in relation to paying Medicare.

In one such case, skilled nursing care for a patient was argued to have been denied because the patient was not expected to improve in the long term. In the case of Jimmo vs. Sebelius, the improvement standard was considered and never directly addressed. The decision instead was that skilled care would not be covered when less skilled care would suffice. The Center for Medicare Services declared that they would do an educational campaign to address the issue of the improvement standard. Read more here: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf

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