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HomeHealthHealth careCongress should adopt site-neutral post-acute payments: MedPAC

Congress should adopt site-neutral post-acute payments: MedPAC

The Medicare Payment Advisory Commission will suggest Congress decrease the funds to all post-acute care settings besides long-term care hospitals and look to undertake smaller, site-neutral insurance policies that needs to be phased out if and when a unified fee system is applied.

Industry associations, regardless of usually agreeing with a post-acute care potential fee system, cautioned in opposition to taking such motion earlier than factoring within the affect of the present updates and the pandemic.

Presenting the draft suggestion final week, the fee tasked with evaluating the prototype fee system mentioned the most important hurdle was the various fee adjusters of site-specific insurance policies included in its design.

“Each [companion] policy is likely to be controversial, require considerable resources to develop and take many years to implement,” mentioned Carol Carter, principal analyst at MedPAC, through the fee’s month-to-month assembly.

The fee really useful the Centers for Medicare and Medicaid Services implement less complicated, setting-agnostic insurance policies on a smaller scale and, whereas CMS phases out these insurance policies, decrease the fee ranges for expert nursing services and residential well being and inpatient rehab services as they exceed care prices. 

Given the excessive fee variance between settings regardless of having a affected person base with related circumstances and comorbidities, Congress tasked MedPAC with evaluating a prototype fee system for all post-acute care suppliers–expert nursing services, inpatient rehab services, dwelling well being and long-term care hospitals–that might be based mostly on affected person traits, not the setting, and use affected person stays because the unit of service with a typical set of threat adjusters.

The separate fee plans not solely make the standard measures and affected person assessments tough to check however, earlier than the latest updates to the setting-specific potential fee methods, additionally gave method for long-term care hospitals to confess extra sufferers with much less extreme or complicated circumstances and incentivized nursing houses and rehab services to push pointless therapies. The prototype’s design additionally features a separate adjuster for dwelling well being care and no adjusters for rural services, low-income beneficiaries or these with earlier hospital stays.

Carter mentioned the prototype’s design must also embody a performance-based worth incentive program that would come with affected person expertise and social threat measures. She warned, nevertheless, that separate fee adjusters would weaken the PPS’ uniformity, noting the contentious tradeoffs in standardizing advantages and cost-sharing throughout all post-acute care settings.

As a lot as post-acute supplier teams appear to be on board with a uniform fee system, they continue to be involved about utilizing information units from earlier than the pandemic–significantly with the disproportionate affect that COVID-19 had on nursing houses.

While additionally involved with the potential prices related to the upcoming staffing mandate in June, dwelling well being suppliers and expert nursing services are nonetheless contending with the phased-in patient-driven models now of their second yr of parity changes.

“The impact of new payment systems implemented in both skilled nursing and home health care are both in the assessment phase and undergoing parity adjustments. Ideally, before a unified payment model is considered, the impact of those payment systems must be understood,” mentioned Janine Finck-Boyle, vp of regulatory affairs for LeadingAge, the affiliation of nonprofit suppliers of ageing providers, in an e mail.

“But done right and done well, we believe a PAC unified payment model holds promise and could result in more choices for people who need post-acute care,” Finck-Boyle mentioned. 

The American Health Care Association and National Center for Assisted Living additionally cautioned in opposition to taking any motion too quickly.

“While we appreciate efforts to modernize and improve Medicare payment accuracy and adequacy, we are concerned about CMS’ observations surrounding challenges with the prototype and urge policymakers to refrain from any action until those challenges have been addressed,” the teams mentioned in an e mail.



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