MedPAC makes headway on unified post-acute payment system

Skilled nursing providers and inpatient rehab facilities offer clashing views on Medicare payments
Skilled nursing providers and inpatient rehab facilities offer clashing views on Medicare payments

A prospective payment system that encompasses all post-acute care settings will be presented to Congress next year, the Medicare Payment Advisory Commission said Friday.

One unified payment system, based on patient characteristics rather than setting, would be “reasonably accurate,” MedPAC officials said during a meeting to report on the system's progress. The new PPS would cover payments for skilled nursing facilities, inpatient rehabilitation facilities, home health agencies and long-term care hospitals.

While a new, unified system would prevent providers from increasing therapy to receive higher reimbursements, MedPAC officials stressed that it would still be based on a fee-for-service system and shouldn't be the “end point” for overhauling post-acute payments. Additional policies, including readmissions penalties and value-based purchasing, may be added at a later date to “dampen fee-for-service incentives.”

While provider groups have praised site-neutral payment models in the past, MedPAC's recommendations may not be followed by Congress.

An update to the post-acute payment system was required as part of the Improving Medicare Post-Acute Care Transformation Act of 2014. MedPAC will present its prototype PPS to Congress in June.