TABLE 1.

Examples of Relevant Interview Protocol Questions

Participant Role	Example Questions
MA CMO	What are some challenges you face paying for PAC?
	• Is this an area of cost growth for your plan?
	• If so, what do you think are the primary cost drivers of PAC for your population?
	• Please tell me about the use of PAC in your beneficiary population. Is addressing the use of PAC a focus for you?
	What strategies do you use to ensure the appropriate use of PAC?
	• How do clinical characteristics and patient preferences impact the site of PAC?
	• What strategies do you use in terms of intensity of care (ie, discharge setting, number of days in SNF or home healthcare, therapy frequency, length of therapy sessions)?
	• How do you think these strategies have helped the appropriate placement of patients?
MA care manager	How do you identify plan members who may need PAC?
	• Are hospitals required to notify the plan when a PAC stay is anticipated?
	• Do members themselves alert the plan?
	• Do you have care managers present at all member hospitals?
	• Do care managers visit SNFs? What are their goals and how does that work?
	• How do you communicate with plan members, hospital staff, and/or PAC providers about care planning?
	Example case:
	To better understand how discharges are done in practice, I would like you to consider the following patient.
	Ms Jones is a 78-year-old woman who had a fall at home, which resulted in a hip fracture. Except for some hypertension, she was relatively healthy and active, often going to the senior center. Medically, she is stable. She is being discharged for rehabilitation.
	• Please walk me through how you would approach managing PAC placement for this patient.
	› What options would you present to the patient and family?
	› Please tell me about how you decide where to send this patient for PAC.
	› How do you approach the topic of which facility to recommend?
	› How would you decide how long she’d need to stay in PAC?
	› What other factors might alter the PAC arrangements for Ms Jones?
Hospital VP of strategy	How are decisions made about where to discharge patients needing PAC?
	• Please tell me about any procedures or guidelines you have regarding the discharge of patients to SNFs.
	• How are these guidelines communicated to discharge planners?
	• Are there any specific written policies to describe this?
	• How do managed care plans influence the choice of postacute provider?
	• Can you give me an example?
Hospital discharge planner	Example case:
	To better understand how discharges are done in practice, I would like you to consider the following patient.
	Ms Jones is a 78-year-old woman who had a fall at home, which resulted in a hip fracture. Except for some hypertension, she was relatively healthy and active, often going to the senior center. Medically, she is stable. She is being discharged for rehabilitation.
	• Can you describe whether the discharge planning process would differ if Ms Jones were enrolled in a Medicare managed care plan?
	› What influence does the plan have?
	› Are there differences in this by plan?
SNF administrator	Can you describe your contracting experience with Medicare managed care plans?
	Can you walk me through how Medicare managed care plans influence the use of postacute services provided to your patients?
	• What oversight do they provide?
	• Are co-payments or preauthorization involved?
	• Are some managed care patients admitted to SNF without a prior 3-day hospital stay?
	Please share any additional perspectives you may have about your relationships with Medicare managed care plans.
SNF admissions coordinator	What factors do you think influence the decision of where patients are sent for PAC?
	• What is the role of the case manager at the hospital?
	• Tell me how managed care plans might influence choice (and if this has changed).
	• Please tell me how patients and their families may be engaged in the selection process.
SNF director of nursing	Based on our data, we’ve noticed decreasing lengths of SNF stay. Potential factors in this could include changes in the market, such as increased use of managed care, new accountable care organizations, and focus on quality and costs, among other things.
	• What has been your facility’s experience with length of stay?
	• What would you attribute that to?
	• How has changing length of stay affected the facility or how you provide care?

CMO indicates chief medical officer; MA, Medicare Advantage; PAC, postacute care; SNF, skilled nursing facility; VP, vice president.