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 MedPAC: A Unified, Post-Acute Payment System 'Feasible'

Washington, 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.
 
Moving 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.
 
Despite 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 care.
 
The 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.
 
Many providers, and patient advocates, are worried that Washington’s latest craze for whatever everyone calls—but no one has defined—“value-based purchasing” will leave patients in the lurch by focusing on cost, not on value.
 
Despite 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.
 
“Our 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.”
 
Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.
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