Between 2000 and 2001,  SNFs’ average amount of nursing time changed little, remaining slightly  under 3 and one-half hours per patient day. For most categories of SNFs, changes in staffing ratios were small. The share of a SNF’s patients who were covered by Medicare was not a  factor in whether facilities increased their nursing time. Although SNFs with higher total margins in  2000—that is, those with revenues substantially in excess of costs—might  have been best able to afford increases in nursing staff, those with the  highest total margins did not raise their staffing substantially more than  others. Although  the payment change could have paid for about 10 added minutes of  nursing time per patient day for all SNF patients, we found that on average  SNFs increased their staffing ratios by less than 2 minutes per patient day. Matter for Congressional Consideration

Our analysis of available data on SNF nursing staff indicates that, in the  aggregate, SNFs did not have significantly higher nursing staff time after  the increase to the nursing component of Medicare’s payment. Data Sources Considered

To assess the impact on nurse staffing ratios of the April 1, 2001, increase  in the nursing component of the SNF payment, we needed a nationally  uniform data source that included the number of patients and the number  of nursing staff (full-time equivalents (FTE)) or nursing hours, for two  periods—before April 1, 2001, to establish a baseline, and after April 1,  2001. Related GAO Products

Skilled Nursing Facilities: Providers Have Responded to New Payment  System By Changing Practices.
Why GAO Did This Study

The nation's 15,000 skilled nursing facilities (SNF) play an essential role in our health care system, providing Medicare-covered skilled nursing and rehabilitative care each year for 1.4 million Medicare patients who have recently been discharged from acute care hospitals. In recent years, many analysts and other observers, including members of Congress, have expressed concern about the level of nursing staff in SNFs and the impact of inadequate staffing on the quality of care. GAO's analysis of available data shows that, in the aggregate, SNFs' nurse staffing ratios changed little after the increase in the nursing component of the Medicare payment took effect. Overall, SNFs' average nursing time increased by 1.9 minutes per patient day, relative to their average in 2000 of about 3 and one-half hours of nursing time per patient day. For most SNFs, increases in staffing ratios were small.

What GAO Found

Further, GAO found that the share of SNF patients covered by Medicare was not a factor in whether facilities increased their nursing time. Similarly, SNFs that had a total revenues considerably in excess of costs before the added payments took effect did not increase their staffing substantially more than others.