MedPAC discusses limiting patients' post-acute options

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MedPAC Chairman Glenn Hackbarth
MedPAC Chairman Glenn Hackbarth

Medicare rules might have to be relaxed to give hospitals more say in where patients go for post-acute care, members of the Medicare Payment Advisory Commission proposed at a recent meeting in Washington, D.C.

It's likely that many hospitals already are “soft steering,” some commissioners said. In this technique, hospital representatives discuss post-acute care options with patients, emphasizing which facilities have stronger quality measures or otherwise encouraging patients to choose a certain provider. For example, the hospital might want to steer patients to a skilled nursing facility that sends few people back, so that the hospital is less likely to face Medicare penalties for high readmissions.

Providers have expressed anxiety around “soft steering,” because Medicare regulations mandate that patients should have a choice of provider. The commissioners discussed eliminating this confusion by authorizing “hard steering.” There was some debate about what this would mean: It could potentially let hospitals severely limit patient choice to two or three facilities, some of the commission members proposed.

A potential benefit of hard steering is that it might make it easier to achieve high-quality care coordination by funneling more patients to post-acute providers that achieve excellent results.

And patients might not mind limitations on post-acute options, conjectured Commissioner Craig Samitt, M.D. He said beneficiaries likely value choice the most in picking a primary care physician, specialist and hospital, and that the value is “less” in the post-acute space.

Congress is not required to act on MedPAC recommendations. However, post-acute providers should take the group's latest discussion to heart, LeadingAge Director of Long-Term Care Finance and Policy Heather Boyd wrote in a blog post Thursday. Providers should focus on improving their quality measures and forging strong relationships with hospitals, she advised.

Click here for a transcript of the full Oct. 10 MedPAC meeting.