{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:51:48Z","timestamp":1777877508197,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2019,6,13]],"date-time":"2019-06-13T00:00:00Z","timestamp":1560384000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Neurohospitalist"],"published-print":{"date-parts":[[2020,4]]},"abstract":"\n Background:<\/jats:title>\n The costs of multiple sclerosis (MS) disease-modifying therapies (DMTs) and certain symptomatic treatments (ie, dalfampridine [DFP]) are high. Consolidated billing models require that medication costs be covered by skilled nursing facilities (SNFs) after hospitalization. As a result, patients may experience suboptimal discharge, off of medication or without rehabilitation.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n To characterize the frequency with which MS pharmaceutical costs lead to suboptimal discharge, we performed a retrospective chart review of admissions to a large academic medical center from January 2013 to December 2017 among patients with MS on DMT and\/or DFP with SNF rehabilitation recommendations. We quantified the burden of suboptimal discharge due to medication discontinuation, limited medication supplies, or forgone rehabilitation.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Among 169 admissions of patients with MS with discharge recommendations for SNF rehabilitation, there were 57 (33.7%) admissions across 49 patients with MS on DMT\/DFP. Overall, 39 (68%) of 57 admissions (71% of patients) experienced a suboptimal discharge. Overall, 29 (65%) discontinued DMT\/DFP, 9 (16%) took their remaining home supply of medications during rehabilitation (including 5 admissions also affected by a discontinuation), and 6 (11%) were discharged home to remain on DMT. Among those discharged to rehabilitation, discharge to a hospital-owned SNF was associated with a routine discharge with no lapse in medication (n = 11\/15 vs 7\/36, P < .001).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n High costs of MS medications in conjunction with SNF consolidated payment models result in misaligned incentives and often lead to medication discontinuation or other suboptimal discharge for patients with MS.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/1941874419855909","type":"journal-article","created":{"date-parts":[[2019,6,14]],"date-time":"2019-06-14T00:05:47Z","timestamp":1560470747000},"page":"82-87","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Difficult Discharges to Skilled Nursing Facilities Attributed to Multiple Sclerosis Medications: An Observational Study"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2581-9293","authenticated-orcid":false,"given":"Kathleen C.","family":"Munger","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin P.","family":"George","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA"},{"name":"Department of Neurology, Yale University School of Medicine, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence M.","family":"Samkoff","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica F.","family":"Robb","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,6,13]]},"reference":[{"key":"bibr1-1941874419855909","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001608"},{"key":"bibr2-1941874419855909","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.0853001"},{"key":"bibr3-1941874419855909","unstructured":"Consolidated Billing. 2015. https:\/\/www.cms.gov\/Medicare\/Medicare-Fee-for-Service-Payment\/SNFPPS\/ConsolidatedBilling.html. Accessed July 28, 2018."},{"key":"bibr4-1941874419855909","first-page":"41644","volume":"64","year":"1999","journal-title":"Federal Register"},{"key":"bibr5-1941874419855909","unstructured":"Lexi-Drugs. Lexicomp. Riverwoods, IL: Wolters Kluwer Health, Inc. 2019. http:\/\/online.lexi.com. Accessed April 18, 2019."},{"key":"bibr6-1941874419855909","unstructured":"American Health Care Association. FY 2018 Medicare SNF PPS Rate Calculator. 2018. https:\/\/www.ahcancal.org\/research_data\/funding\/Pages\/MedicareRateCalculator.aspx. Accessed July 28, 2018."},{"key":"bibr7-1941874419855909","unstructured":"Schweitz M. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2014; Proposed Rule. 2013. https:\/\/csro.info\/getattachment\/bd3f8a0f-11ea-4007-900e-f0baa07e63c5\/2013-07-01_CSRO-SNF-CB-Comment.aspx. Accessed May 5, 2019."},{"key":"bibr8-1941874419855909","unstructured":"Skilled Nursing Facility Patients\u2014Consolidated Billing. 2011. https:\/\/www.the-rheumatologist.org\/article\/skilled-nursing-facility-patientsconsolidated-billing\/. Accessed July 28, 2018."},{"key":"bibr9-1941874419855909","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000492"},{"key":"bibr10-1941874419855909","unstructured":"FDA warns about severe worsening of multiple sclerosis after stopping the medicine Gilenya (fingolimod). 2018. https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-warns-about-severe-worsening-multiple-sclerosis-after-stopping-medicine-gilenya-fingolimod. Accessed May 5, 2019."},{"key":"bibr11-1941874419855909","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22163"},{"key":"bibr12-1941874419855909","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2010.257"},{"key":"bibr13-1941874419855909","unstructured":"Miller R. American Health Care Association Letter to Charlene Frizzera, Acting Administrator of the Centers for Medicare & Medicaid Services. 2010. https:\/\/www.ahcancal.org\/advocacy\/letters\/snfppscommentsfy2010.pdf. Accessed July 28, 2018."},{"key":"bibr14-1941874419855909","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.18161"}],"container-title":["The Neurohospitalist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1941874419855909","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1941874419855909","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1941874419855909","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:53:12Z","timestamp":1777589592000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1941874419855909"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,13]]},"references-count":14,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1177\/1941874419855909"],"URL":"https:\/\/doi.org\/10.1177\/1941874419855909","relation":{},"ISSN":["1941-8744","1941-8752"],"issn-type":[{"value":"1941-8744","type":"print"},{"value":"1941-8752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,13]]}}}