2011 Outlook: Post-acute care—Year of parity

Reimbursement and quality improvement are two of the bigger issues facing post-acute-care providers in 2011, with new regulations and federal payment systems kicking in.

A top issue in 2011 for behavioral healthcare providers is the effective implementation of provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which requires private insurers and some Medicaid managed-care organizations to provide equal coverage for mental and physical health.

The coming year will bring full implementation of the mental health parity law, says Mark Covall, executive director of the National Association of Psychiatric Health Systems.

An interim rule implementing the law was released for comment in January 2010. Further changes could come with the issuance of a final rule, but Covall says there has not been an indication from the CMS as to when those final regulations will be released. He says he is not expecting it until the second half of 2011.

Behavioral-health providers also are looking forward to new measures they will begin reporting to the Joint Commission, which will offer an opportunity for inpatient mental health providers to demonstrate their value in a quantifiable way, he says.

Renal-care providers will be experiencing a reimbursement change beginning Jan. 1, 2011, as the sector transitions to a bundled prospective payment system for treatment of end-stage renal disease that will result in most providers receiving a reimbursement cut.

Industry advocates would like to see the CMS fine-tune its interpretation of the law that overhauled reimbursement. As it stands, some argue that providers are going to get hit with a bigger cut in reimbursement than necessary under the change. The cut was calculated based on estimates of how many providers would choose to transition into the new PPS over a four-year period rather than make the switch completely as of 2011, according to the Kidney Care Council, a not-for-profit coalition of dialysis providers.

Renal-care providers want to make sure the PPS is implemented properly and in a way that's not unduly burdensome or creates negative implications for patient care, says Kathy Lester, regulatory counsel to Kidney Care Partners and a partner at law firm Patton Boggs. Kidney Care Partners is a coalition of patient advocates, dialysis professionals, care providers and manufacturers.