MedPAC provides roadmap for post-acute care overhaul

Site-neutral payments would become the norm under a MedPAC plan.
Site-neutral payments would become the norm under a MedPAC plan.

Medicare payments to skilled nursing facilities, home health, inpatient rehabilitation facilities and long-term care hospitals would change under a plan from the Medicare Payment Advisory Commission approved on Thursday.

The proposal would set rates based on patient conditions instead of the care setting. MedPAC gave the greenlight to the plan in January but then needed to go through formal review steps. In June, the panel will submit an official report to Congress, which is under no obligation to act on its recommendations.

IRF providers in particular have balked at so-called site-neutral payments, while long-term care lobbyists have generally lauded them. But long-term care officials such as LeadingAge's Cheryl Phillips, M.D, this week also have indicated skilled nursing facilities should remain cautious.

In other moves, MedPAC also passed recommendations on Medicare Part D Thursday. They are estimated to save the government as much as $2 billion in one year and $10 billion over five years. But some of those policy proposals, such as removing antidepressants, have caused a backlash. In a statement, the CEO of the National Alliance on Mental Illness called the recommendation “misguided.”

In addition, MedPAC staff members told panelists Friday that a three-year dual-eligible demonstration project was foundering, according to a report from Bloomberg BNA. The project seeks to make more efficient use of medical and other supports for individuals eligible for both Medicare and Medicaid, but enrollment and other expectations have come up short. Locating eligible enrollees and resistance from some providers have been big problems, noted the staffers, who said they might offer recommendations soon.