MedPAC holds off on recommendation for site-neutral payments for post-acute care

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All ACOs should be exempt from 3-midnight requirement for Medicare coverage, MedPAC says
All ACOs should be exempt from 3-midnight requirement for Medicare coverage, MedPAC says

The Medicare Payment Advisory Commission discussed equalizing reimbursements for different post-acute providers but did not issue a formal recommendation at a meeting last week.

This was the second time in recent months that MedPAC has taken up the topic of reimbursing skilled nursing facilities and inpatient rehabilitation facilities at the same level for certain services. Nearly all the commissioners support these site-neutral payments, Chairman Glenn Hackbarth said after the group's November meeting.

Stroke, major joint replacement and hip/femur procedures are the conditions being considered for equalized payments, according to presentation materials from Thursday's meeting. The three conditions represent about one-quarter of all IRF patients.

The services provided by the two different provider types and the patient outcomes they achieve are similar, the presenters noted. IRF reimbursements generally are higher than those for SNFs, so site-neutral payments could mean savings for the Medicare program. Under current policy, IRFs receive about $22,400 per discharge for a stroke patient with a comorbidity or complication, compared with about $17,400 for a SNF, according to the presentation materials.

The commissioners also considered how equalizing payments could help pave the way toward bundled payments for post-acute services, the Bureau of National Affairs reported.

The American Health Care Association/National Center for Assisted Living, the nation's largest long-term care provider association, supports site-neutral payments. MedPAC's discussions are encouraging, said AHCA/NCAL President and CEO Mark Parkinson last week.

“When Medicare reimburses different providers at different rates for the same post-acute services, that is not beneficial for the patient nor the taxpayer,” Parkinson said. “A site-neutral payment system would encourage providers to offer higher-quality services in the most effective manner.”

MedPAC advises Congress on Medicare policy. Lawmakers are not obligated to act on the recommendations from the commission, which seeks ways to maximize savings for the Medicare program.

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