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 MedPAC Examines Uniform Outcome Measures for Post-Acute Care

The Medicare Payment Advisory Commission (MedPAC) continues to explore what a unified payment system for post-acute care (PAC) in the Medicare program would look like despite what an industry analyst says is no apparent movement to do so in Congress.

At its most recent public meeting, the commission heard a staff report on the basis for uniform outcome measures as part of such a unified payment model for skilled nursing facilities (SNFs), home health agencies (HHAs), long term care hospitals (LTCHs), and inpatient rehabilitation facilities (IRFs).

Just last month, MedPAC released its March Report to Congress that recommends for fiscal year 2019 Congress “eliminate the market basket update for SNFs for fiscal years 2019 and 2020 and direct the secretary [of Health and Human Services] to implement a redesigned prospective payment system [PPS] in fiscal year 2019 for SNFs.”

For this latest review, the commission heard from staff member Carol Carter on unified outcome measures, which the staff report said are needed to compare provider performance across PAC settings. “The program will be able to evaluate the quality and the value of its purchases while providers and beneficiaries will be able to directly compare outcomes for different types of PAC providers,” she said.

A second basis for uniform outcome measures is when the Centers for Medicare & Medicaid Services (CMS) implements a unified PAC payment system, it will be critical to monitor provider performance, including whether providers maintain quality of care and furnish appropriate use of PAC and other services.

Carter said the last reason for the measures is for their possible use in a value-based purchasing policy for all PAC providers. “By tying a portion of a provider's payments to its performance on quality and resource use, providers would have an incentive to achieve good outcomes while using resources efficiently,” she said.

An example of what the uniform measures would address is the area of readmissions, which include uniform, risk-adjusted readmission rates for HHAs, SNFs, and IRFs. LTCHs are excluded because some readmissions cannot be detected due to the interrupted stay policy and no patient assessment information at the time of the study, Carter said.

In analyzing what MedPAC is doing on the potential new PAC payment model, Erica Breese, director, Avalere Health, tells Provider while MedPAC continues to focus on the unified PAC payment system, there has been no movement to do so on the congressional front.

“So, my take is the commission is continuing to develop building blocks for this system that as of yet has not gotten any traction on [Capitol] Hill. They are moving forward, but I am not seeing anything move on the legislative or agency [CMS] front,” she says.

While some of the measures of a new payment model for PAC can be done at the agency level, a unified PAC payment system would need legislative support, most likely in the form of being tacked onto a larger bill in Congress.

If nothing happens on a new payment model, SNFs and other PAC providers will remain in the status quo on how reimbursement works. “There will still be four settings all paid on their own prospective payment systems,” Breese says.

In general, she believes a new unified payment model would be a mixed bag for SNFs, but likely providers would benefit from the current separately paid system. “It would be a huge shift in four industries, and most providers tend not to like major shifts and like their own individualized payment system,” Breese says.

For more information on the April public meeting and uniform outcome measures, see The commission’s next public meeting is in September. 

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