D.C.—A unified Medicare prospective payment system for all post-acute care is “feasible”
and would actually improve patient care by “dampening incentives” for providers
to cherry-pick the most profitable kinds of rehab work, leaders of the Medicare
Payment Advisory Commission (MedPAC) were told Friday.
to a prospective payment system “would break down the silos between settings,” staffers told the commission as its monthly
two-day meeting wrapped up. Staffers urged commissioners to recommend that
Congress use “functional assessment data” to “calibrate” payments for some
patients, but that some kind of policy governing short stays would be required.
Additionally, “low-volume, isolated providers”—especially in rural areas—“may
need protection” under a new payment scheme, the MedPAC staff report says.
the broad agreement over site neutrality, the controversial question of skilled
nursing’s Medicare profit margins was very much at the heart of Friday’s
presentation (not withstanding MedPAC staff’s recommendations that payments be
raised for providers that treat "medically complex” cases). Staff forwarded on
figures that they claimed showed how easy it is to profit on many kinds of
commission meets monthly, but Thursday’s and Friday’s sessions were especially
charged after the Department of Justice announced that it had reached a $133 million False Claims Act settlement with Kindred Healthcare and four other
providers over allegations that the companies were bilking Medicare with
needless, or fraudulent, therapy.
an evolving position on site neutrality and other issues, MedPAC still seems to
many providers to be intent on hacking everywhere, even if it means it cuts
more muscle than fat.
profession consistently faces financial uncertainty and is forced to do more
with less,” says Len Russ, a New York private operator and former chair of the
board at the American Health Care Association. “We need a thoughtful, efficient
payment system that is not only consistent with other sectors, but also
empowers our providers to deliver the highest-quality care for millions of
patients and residents. They are depending on us to get it right.”
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