Final unified post-acute care pay system is coming
Original article from modernhealthcare.com
The Medicare Payment Advisory Commission is wrapping up a report that outlines a unified payment system for post-acute care settings. The panel will vote on a formal report next month. It also plans to suggest the CMS accelerate its timeline of when the new pay scheme will see the light of day.
The new pay policy will change the way Medicare reimburses skilled-nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term-care hospitals. It would establish rates according to specific patient conditions instead of the kind of post-acute-care setting hosting the beneficiary.
Congress defined all four of these entities as post-acute care providers and directed MedPAC to develop a plan to pay these providers under one prospective payment system, as opposed to separately as they currently are paid.
By June, MedPAC needs to send a report to the CMS and Congress that recommends the features of a unified payment system and the potential effects of moving to such a system. HHS will have until 2022 to develop an actual pay prototype, and MedPAC will need to weigh in via a report by 2023, according to the timeline outlined in legislation.
A unified post-acute care payment system will have the most adverse impact on inpatient rehabilitation facilities and long-term-care hospitals, according to a MedPAC analysis. That’s because many of the types of stays treated in these settings are also treated in lower-cost settings.
Therefore, the predicted costs for these settings will be lower than their actual costs because the model will average out payment, MedPAC said. A transition period would give long-term-care hospitals and inpatient rehabilitation facilities time to adjust their costs.
Skilled-nursing facilities will benefit because payments would consider the medical complexity of patients often treated there.
The new pay strategy would generally raise payments to providers that treat medically complex patients. HHS Secretary Sylvia Mathews Burwell must consider the need to adjust for low-volume, isolated providers, Carol Carter, MedPAC’s principal policy analyst, said Thursday.