Has MedPAC been infiltrated?

James M. Berklan
James M. Berklan

Don't look now, but it appears that nursing home operators might have sneaked one of their own onto the Medicare Payment Advisory Commission.

That was the bemused thought Tuesday upon reading the latest report from the Congressional advisory panel for Medicare spending.

In a publication eight chapters and nearly 300 pages long, there were recommendations made after only one chapter. That would be Chapter 7: “Hospital short-stay policy issues.”

Maybe it's because the federal government is coaxing so much coziness among providers of different acuities, but a quick glance made it seem that this chapter was about skilled nursing providers nearly as much as hospitals.

And the voting results sounded like a nursing-home lobbyist's Christmas wish list come true. Just what would Clif Porter or a Larry Minnix minion look like in disguise, anyway?

In 7-1, MedPAC voters said they want the nation's highest health official to focus on recovery audit contractors and some of the allegedly bad things they do. (OK, score one for nursing homes and hospitals there.) But in that same sub-section, commissioners said to focus on hospitals with the highest rates of short inpatient stays, AND do away with the “two-midnight” rule.

Skipping to 7-3, the news got better: Count up to two outpatient observation days to tally toward the criterion for the three-inpatient-day hospital eligibility requirement! Huzzah!

Long-term care lobbyists have stoked numerous legislative efforts to peck away at that nettlesome thicket. This can be seen only as helping the effort.

And then comes 7-4. Oh, that mighty 7-4.

That's where MedPAC voters pounded their fists on the ballot box to demand nothing less than submission out of those hospital operators who would haughtily overuse their “observation stay” rubber stamp on patients.

Notify thy neighbors, the commissioners thundered, when they are in outpatient observation status for more than 24 hours so their “financial liability for skilled nursing facility care” will be clear! Not only that, but the notice “should be timely, allowing patients to consult” with doctors and other healthcare professionals before they're discharged.

In other words, stop trying to slip easily confused — or not-so-easily-confused — people into extended “observation” stay status. That tends to cause problems later on when they either can't afford skilled nursing care they didn't know didn't quality for Medicare coverage, or just don't try to get into skilled nursing.

On top of all this good news, the only commissioner out of 16 not voting for any of these changes was the only one not there. In other words, unanimous (as MedPAC votes tend to go).

Which raises the question again: Are long-term care lobbyists MedPAC-ing the place?

We can't really put anything past them, can we, given some other recent successes they're taking credit for. They're claiming victory, for example, on provider agreements and with the “doc fix.” The latter actually trims their pay for a while — just not as badly as long feared.

So it seems clear: As the long-term care lobby will tell you, it's on a roll.

But this MedPAC mole theory admittedly might have a few holes in it. There are hundreds of other pages in this week's MedPAC release, some of them favorable and some of them not as favorable to long-term care providers.

And then there's still that little issue of commissioners doing their twice-yearly Grinch impersonations with “no raise” for skilled nursing providers votes. We can't forget about those.

But there's another thing that can't be forgotten: The lawmakers MedPAC is supposed to be advising frequently treat the panel like a teen-ager treats a parent with inconvenient advice.

James M. Berklan is McKnight's Editor. Follow him @JimBerklan.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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