B. Consumers Paying for LTSS Through Private Health Insurance Policies
A second category of consumers consists of people who need LTSS such as inpatient or outpatient rehabilitative care, medication, or equipment management for a short period of time following an acute illness or procedure. 101 Such care is not intended to be custodial or maintenance, 102 but rather is intensive enough that it is expected to get the consumer to a point at which hospital readmission103 and further LTSS are unnecessary. Not surprisingly, people with no insurance coverage often experience significant barriers in accessing post-acute care, 104 but many people in the paradoxically- named short-term LTSS category have health insurance policies obtained through present or past employment or individual purchase that will pay for all or part of those prescribed short-term LTSS consented to by the consumer. The various general possible impacts of health industry consolidation outlined in Section II, supra, are possible for this consumer population. Additionally, as health insurers consolidate into a smaller number of competitors, researchers should particularly investigate whether those insurers begin to reduce their benefits for short-term LTSS by refusing to cover previously-covered services, reimbursing providers at lower rates, and/or shifting more of the associated costs to the consumer through increased deductibles or co-insurance105 contractual obligations. If such changes in health insurance coverage for post-acute care occur widely, the role of those involved in hospital discharge planning106 will become even more central for consumers.
101. “Post-acute care (PAC) includes rehabilitation or palliative services that beneficiaries receive after, or in some cases instead of, a stay in an acute care hospital. Depending on the intensity of care the patient requires, treatment may include a stay in a facility, ongoing outpatient therapy, or care provided at home.” Post-Acute Care, MEDPAC, http://medpac.gov/-research-areas-/post-acute-care (last visited Apr. 13, 2016). 102. See Sidney D. Watson, From Almshouses to Nursing Homes and Community Care: Lessons from Medicaid’s History, 26 GA. ST. U. L. REV. 937, 962 (2010) (“[P]rivate insurance rarely covers personal care.”). 103. See generally Maxim Topaz et al., Higher 30-Day and 60-Day Readmissions Among Patients Who Refuse Post Acute Care Services, 21 AM. J. MANAGED CARE 424 (2015) (stating that patients who refuse post-acute care are twice as likely to have 30- and 60-day readmissions). 104. See Courtenay R. Bruce & Mary A. Majumder, The “Permanent” Patient Problem, 42 J.L. MED. & ETHICS 88, 88 (2014) (“[P]ost-acute care facilities have no financial incentive or legal obligation to accept patients with no insurance or only pending Medicaid coverage.”). 105. Coinsurance is defined as “[y]our share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.” Coinsurance, HEALTHCARE.GOV, https://www.healthcare.gov/glossary/co-insurance/ (last visited Apr. 13, 2016). 106. Hospital Discharge Planning: A Guide for Families and Caregivers, FAMILY CAREGIVER ALLIANCE, https://www.caregiver.org/hospital-discharge-planning-guide- families-and-caregivers (last visited Apr. 15, 2016) (“[D]ischarge planning is ‘[a] process used to decide what a patient needs for a smooth move from one level of care to another.’”).