The timing couldn't have been better for HCFA's town hall-style meeting with nursing home providers late last week.
The beleaguered nursing home industry, facing mounting losses from a Medicare prospective payment system and stricter quality enforcement, took its case to HCFA's Baltimore headquarters in an eight-hour meeting.
A packed house of about 500 providers argued for extra payments for their most serious cases, similar to "outlier" payments acute-care hospitals receive.
While some providers decried the politics involved in payment policy, a congressman in attendance acknowledged the system is flawed.
Rep. Benjamin Cardin (D-Md.) told those at the meeting that he plans to reintroduce a bill that would eliminate the controversial caps on non-ancillary therapy services, such as physical and occupational therapy. The caps, which set a $1,500 per-patient, per-year limit on the amount of treatment Medicare will cover, were established by the Balanced Budget Act of 1997.
Other members of Congress also have expressed concern about the impact of the 9-month-old Medicare PPS for skilled-nursing facilities. That includes Rep. William Thomas (R-Calif.), chairman of the House Ways and Means Committee, who asked HCFA Administrator Nancy-Ann Min DeParle to hold last week's meeting with skilled-nursing facilities.
Senate Budget Committee Chairman Pete Domenici (R-N.M.) told HHS Secretary Donna Shalala at a committee hearing late last week that he fears an industry meltdown is coming.
"If we wait until next year to update reimbursement, we will lose a great number (of nursing homes) to bankruptcy," Domenici said.
The meeting covered:
* A possible payment system update, which HCFA said will not be coming before October 2000.
* Caps on outpatient therapy expenses.
* Skilled-nursing coverage and medical review.
* Nursing home quality issues.
HCFA is still working on a final rule for skilled-nursing payment. The public comment period on the interim final regulations ended Dec. 28, 1998.
Rehabilitation hospitals had a keen interest in last week's meeting because they face similar changes in Medicare reimbursement.
Lobbyists for rehabilitation providers met with HCFA officials earlier this month to argue against a system based on resource utilization groups, or RUGs, which is how skilled-nursing facilities are reimbursed. The rehabilitation providers and the Medicare Payment Advisory Commission favor a discharge-based system like the one used to pay acute-care hospitals.