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 MedPAC Seeks Ways to Increase Use of High-Quality PAC Providers

In a staff presentation before the Medicare Payment Advisory Commission (MedPAC), the nonpartisan board on Sept. 7 examined how to encourage Medicare program beneficiaries to use higher-quality post-acute care (PAC) providers.

The starting point for the discussion focused on improving the information available to beneficiaries on PAC options and eliminating regulatory barriers that limit acute-care hospitals from making referrals to PAC providers.

The MedPAC staff report said hospitals and patients alike are affected by the choice of a PAC provider, with the hospital possibly suffering penalties for some readmissions, and they could possibly lose incentive payments if part of an accountable care organization (ACO), for example. Beneficiaries, if not taken care of in a high-quality PAC, may see diminished health status and longer stays in the hospital, the report said.

It is a daunting task for many beneficiaries to select a PAC provider, the MedPAC staff said, with the physical and mental condition of the patient often limiting the process as well as the often-quick discharge process. The patient or family may not have any prior knowledge of where to even look for care after the hospital stay. MedPAC staff said there is also the factor that when a PAC provider is located, it may not be suited for the specific needs of the beneficiary or even have room to take on a new patient.

While there is information publicly available for beneficiaries to use to assess their PAC provider options, MedPAC staff noted that the availability of Nursing Home Compare and Home Health Compare does not appear to “increase utilization of higher-quality providers.”

For example, MedPAC conducted an analysis using a composite of quality scores for PAC providers and beneficiary PAC provider choices and discovered that 77.1 percent of beneficiaries could have selected a “higher quality” skilled nursing facility (SNF) within a 15-mile radius of their home.  

From the provider end, the report said there is a wide variance in the geographic locations of PAC providers and just as broad of a scope of the quality of care provided, making beneficiary selection challenging in many instances.

 

MedPAC staff also discussed current hospital payment policies, which impact PAC referrals. These include hospital readmission value-based purchasing (VBP) programs, as well as alternative payment and delivery systems (APM) such as ACOs and bundling demonstrations, which also influence PAC referrals.

Under both hospital VBP program measures, as well as APMs, MedPAC said hospitals have financial incentives to refer to lower-cost and higher-quality providers, but possess limited authority to do so.  

As a result of its report, MedPAC staff offered preliminary recommendations for the commission to highlight hospital discharge planning responsibilities, which include assessing patient post-hospital care needs, educating beneficiaries about their post-hospital needs and options, facilitating transfers to PAC when necessary, and providing a list of SNFs and home health agencies (HHAs).

 

MedPAC staff also brought up the fact that the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) included a requirement that quality be included in hospital discharge planning. There has, however, been no further action on a proposed regulation from 2015 to implement this provision.

Longer term, MedPAC staff recommended expanding the Hospital Readmissions Reduction Program to include more conditions as well as implement additional PAC VBP programs beyond the current SNF Rehospitalization VBP and the HHA VBP programs that currently remain as demonstration projec

.

MedPAC is an advisory board, and Congress is not obligated to act on MedPAC’s recommendations.

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