Thursday, November 14, 2013

MedPAC Steps Closer to Site Neutral Payment System

Last Thursday, November 7th, MedPAC (the independent Congressional agency that advises Congress on Medicare issues) met to discuss, well, Medicare. They covered a wide number of topics, ranging from synchronizing Medicare policy and measuring quality across delivery systems, to ACOs, to Medicare managed care. One topic on their agenda that caught AHCA’s eye was “rationalizing Medicare’s payment for post-acute care.”

MedPAC acknowledges that prices between inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) vary, even though beneficiaries may have similar conditions in both settings. AHCA has been advocating for a site neutral payment system to equalize reimbursement between post-acute care settings and put the focus on patients’ needs, rather than where they receive care. At Thursday’s meeting, MedPAC seemed interested in pursuing this reform.

MedPAC staff found that:
  • SNFs and IRFs offer similar services and treat some of the same conditions
  • Patients achieve similar outcomes in both settings
  • For the same patient, Medicare pays different prices depending on the setting
  • Site-neutral payments would base payments on patient characteristics regardless of where there were treated
The Commission proceeded to approve the following next steps:
  • Uniform prices for select conditions in IRF and SNF
  • Mandating a unified assessment approach for functional status
  • Implementing cross-cutting quality measures
  • Creating a common payment system that combines or all of the existing PAC silos
Check out MedPAC’s presentation from the meeting.

The discussion was a promising step for SNFs, and AHCA will continue to monitor further discussions and provide input when appropriate.

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