The Medicare Payment Advisory Commission on Thursday started the complex work of balancing quality of patient care with building a prototype that may change how Medicare reimburses skilled-nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term-care hospitals.
Congress has defined all four of these entities as post-acute-care providers and under the Medicare Post-Acute Care Transformation Act it has directed MedPAC to develop a plan to have these providers paid under one prospective payment system, as opposed to separately as they currently are paid.
This new system would establish payment rates according to specific conditions afflicting patients instead of what kind of post-acute-care setting hosts the beneficiary.
The change will mean all of these providers will see some sort of fluctuation in payments, which, at the commission meeting Thursday, raised serious questions about the impact to patients.
“How do we ensure the highest quality of care?” said Dr. Craig Samitt, a commissioner and partner at Oliver Wyman, a consulting firm.
Others wanted to mandate evaluation of any model to assess negative impact on patients.
“How will we know if we're doing more harm than good if we recommend a change, but don't know how it turns out?” said Kathy Buto, a commissioner and independent health policy consultant in Arlington, Va.
In 2013, about 42% of Medicare beneficiaries discharged from an inpatient hospital went to a PAC setting: 20% were discharged to a SNF, 17% were discharged to a home health agency, 4% were discharged to an in-patient rehabilitation facility, and 1% were discharged to a long-term-care hospital. PAC spending has more than doubled since 2001, from $27 billion that year to $59 billion in 2013.
MedPAC must submit a report to Congress on this prototype by June 30, 2016.