Payment Reimbursement and Managed Care

Sept. 10-14: Unified Post-Acute Payment System Emerging

September 7, 2018 8:48 am

Among the major changes would be the application of a set of common requirements for all PAC provider types.

Sept. 6—As post-acute care (PAC) leaders gather outside Washington, D.C., for a conference next week, a major payment overhaul is coming together.

Former federal officials and PAC executives will attend the 2ndAnnual Post-Acute Care Integration Summit in Alexandria, Va., starting Sept. 11, but their thoughts may be across the river in Washington, D.C., where a unified Medicare payment model for all post-acute care providers is emerging.

At a Sept. 6 meeting, the Medicare Payment Advisory Commission (MedPAC) praised a preliminary staff proposal to create a unified payment system for skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), and home health agencies (HHAs)

For instance, Kathy Buto, an independent consultant and MedPAC member, described the preliminary PAC payment plan as “a great start.”

Elements of the proposed payment system include setting payments based on patient characteristics, instead of the site of care. The system would create two payment tiers: one for “typical patients” and one for “patients with highly specialized care needs.” The latter group could include those on ventilators, with infectious disease, or suffering from cancer.

“This is a good start, in terms of how we think about the clinical tiering of these patients,” said Susan Thompson, RN, a MedPAC member and senior vice president of integration and optimization with UnityPoint Health, an integrated delivery system.

Wide Variation

There is wide variation in Medicare spending on PAC providers, based on provider type. For instance, in 2016, Medicare paid more than 15,000 SNFs $29.1 billion for 2.3 million stays, while more than 12,000 HHAs received $18.1 billion for 6.5 million episodes, according to the latest MedPAC report.

The proposed payment system would account for some of the distinct requirements of different PAC settings, such as the homebound requirement for HHA patients. And the tier of patients with highly specialized care needs would have condition-specific requirements for PAC providers vying to care for them.

Among the major changes PAC providers would see is the application of common requirements for all provider types. For example, the longtime requirement that Medicare beneficiaries have at least a three-day hospitalization prior to SNF care to qualify for Medicare payment would be extended to HHAs.

However, MedPAC members favored exempting Medicare accountable care organizations (ACOs) from several PAC requirements, including the three-day rule and the homebound diagnosis. 

Brian DeBusk, PhD, a MedPAC commissioner and CEO of DeRoyal Industries, headquartered in Powell, Tenn., said the PAC payment system should further relax existing requirements on advanced alternative payments models that take on downside financial risk.Powell, TN

The commission also appeared to reject the idea of common staffing requirements across PAC providers. For example, all PAC providers except HHAs currently are required to have medical directors.

Marjorie Ginsburg, a MedPAC member and the former executive director of the Center for Healthcare Decisions Inc., said rapidly evolving technological capabilities for remote monitoring could quickly make obsolete any staffing requirements. Instead, MedPAC members said requirements should focus on patient outcomes.

“It’s good not to be too proscriptive about staffing,” DeBusk said. “We need to give them a lot of room to innovate.”

Although some commissioners worried about the impact of placing new requirements on HHAs, others expressed concern that if those organizations were left out of the unified payment schedule, all PAC care would default to more intensive settings.

Monday, Sept. 10

Deadline for comments to the Centers for Medicare & Medicaid Services (CMS) on the proposed rule for the Medicare Physician Fee Schedule and Quality Payment Program (by 5 p.m. ET). Learn more.

Deadline to submit comments to the Federal Communications Commission on the design of the Connected Care Pilot Program to support the delivery of telehealth services to low-income Americans. Learn more.

Oral arguments scheduled for the Texas lawsuit challenging the constitutionality of the Affordable Care Act.

Opening of the submission period for electronic clinical quality measure (eCQM) data for the CY18 reporting period as part of the CMS Hospital Quality Reporting program. Learn more.

Tuesday, Sept. 11

Webinar by America’s Health Insurance Plans titled “Reining in the Cost of Back Pain.” Learn more.

Webinar sponsored by CMS titled “Identifying and Meeting the Language Preferences of Health Plan Members.” Learn more.

Wednesday, Sept. 12

Webinar by HFMA titled “Understanding Medicare’s Final FY 2019 Inpatient Prospective Payment System Rule.” Learn more.

Webinar by CMS titled “FY19 IPPS Final Rule Acute Care Hospital Quality Reporting Programs Overview.” Learn more.

Webinar sponsored by CMS titled “Comparative Billing Report on Licensed Clinical Social Workers.” Learn more

Webinar by CMS titled “Quality Payment Program All-Payer Combination Option Overview.” Learn more

Webinar by the Agency for Healthcare Research and Quality (AHRQ) titled “Healthcare Cost and Utilization Project (HCUP) Overview of HCUP Products and Tools.” Learn more.

Webinar by AHIP titled “The Intelligent Payer: A Survival Guide.” Learn more.

Healthcare Facilities Design Summit 2018, Henderson, Nev. (through Sept. 14). Learn more.

Expected award date for up to $10 million in Affordable Care Act navigator funding. Learn more.

Morgan Stanley Global Healthcare Conference, New York (through Sept. 14). Learn more.

Thursday, Sept. 13

Conference call by CMS titled “New Medicare Card Open Door Forum.” Learn more.

Livestream titled “The Future of Data-Driven Medicine.” Learn more.

Webinar by AHIP titled “Redesign Your Payment Integrity Model to Achieve Savings.” Learn more.

The Health Care Consumer Engagement & Technology Conference, Boston (through Sept. 14). Learn more.

5th Annual Predictive Analytics in Health Care Summit, Boston (through Sept. 14). Learn more.

Web conference by the Advisory Board titled “Understanding the Health Insurance Business: Commercial Insurance.” Learn more.

Webinar by STAT news site titled “Artificial intelligence in health care: the hope, the hype, and the real world impacts.” Learn more.

Friday, Sept. 14

Deadline for applications to join the AHA-AMGA Learning Collaborative. Learn more.


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