60 Seconds With Andrew M. Slavitt, CMS Acting Administrator

Andrew M. Slavitt
Andrew M. Slavitt

Q: What troubles you about the latest OIG study of the nursing home Medicare PPS system? 

A: The number of Medicare Part A payment days continues to rise, and Medicare payments often exceed SNFs' costs.

Q: Why is this happening?

A: A potential cause of this cost issue is that the Medicare Part A therapy payment under the SNF PPS is based primarily on the amount of therapy provided to the beneficiary, regardless of patient condition, which implicitly provides a financial payment incentive for facilities to provide as much therapy to a resident as that resident can tolerate, regardless of the impact of providing this level of therapy on producing positive patient outcomes.

Q: How do you fight this?

A: CMS is working to identify potential alternatives to the existing methodology used to pay for services under the SNF PPS.

Q: How do you plan to strengthen oversight?

A: CMS will work to monitor SNF billing for, and target SNFs that rarely bill for, changes in therapy or frequently use therapy assessments incorrectly for education and claims review.

[Answers excerpted from responses supplied to the Office of Inspector General regarding its report "The Medicare Payment System for Skilled Nursing Facilities Needs to Be Reevaluated" (OEI-02-13-00610).]