A federal panel's recommendation that reimbursement for rehabilitation be the same for inpatient rehabilitation facilities and skilled-nursing facilities is getting immediate pushback from industry stakeholders who say patient care will suffer.
The Medicare Payment Advisory Commission recommended that Congress direct the HHS secretary to eliminate the differences in payments between IRFs and SNFs for selected conditions. It reached this decision after finding overlap in the services provided to patients battling orthopedic, pulmonary and cardiac ailments and infections.
In many of the cases reviewed by MedPAC, the IRF base rates were 49% higher than SNF payments. Creating a site-neutral payment could save Medicare up to $5 billion over five years, according to MedPAC. The panel is also asking Congress that any reductions to IRF payments be phased in over three years.
Industry stakeholders say they are gravely concerned about what will happen if Congress adopts the recommendation. It's likely that IRFs will stop taking cases for which site-neutral payments are being offered, they contend. As a result, more beneficiaries will end up in a skilled-nursing facility where there is less doctor oversight, more limited access to registered nurses and fewer physical therapy sessions, they argue.
“Medical decisions made between a physician like myself and our patients should not be superseded by a policy simply because of cost,” said Dr. Bruce Gans, chairman of the American Medical Rehabilitation Providers Association, in a statement. “Doing so would damage the sanctity of the doctor-patient relationship and force patients into less intensive rehabilitation.”
MedPAC said Thursday it is expecting most IRFs will continue to treat site-neutral conditions despite the cut in reimbursement.
When the recommendation was presented in draft form to commissioners last month, some provider outcry was expected, but support also emerged.
“I support the recommendation and see it as totally aligned with the commission's work to try to get the right payment to the same population, regardless of where they're served,” said Mary Naylor, director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing, at MedPAC's December meeting. “I think this is not an easy path but a necessary path.”
Follow Virgil Dickson on Twitter: @MHvdickson