Providers set sights on pay reform, IMPACT Act implementation

The new year brings a stronger focus on payment reform policies, value-based purchasing and observation stays, said a top executive with the nation's largest nursing home association on Monday.

After a relatively successful 2015 that came with plenty of surprises for providers, the view “out the windshield” shows 2016 could be relatively quiet policy-wise, said Clif Porter, senior vice president of government affairs and public policy for the American Health Care Association.

“History would tell us the legislative agenda during a presidential election year is typically less ambitious,” Porter said during a media conference call. The scenario leaves AHCA “cautiously optimistic” that there will be no major long-term care initiatives on the horizon, he added.

While 2016 may lack a “watershed” policy push like the IMPACT Act or last July's 403-page “mega rule” for nursing homes, Porter cautioned that the year could still bring an increased number of regulations from federal agencies — which would be typical for the last year of a president's second term.

The group's top policy concerns for the coming year include deadlines and measures related to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, and ensuring outcomes associated with the act are “defined in a rational way” and “not just purely cost-focused.” Porter also called the act the “railroad track” of future payments, and noted measures concerning the the measure are likely to be the top regulatory issue the group faces this year.

AHCA is also awaiting cost projections on its proposed payment system from the Congressional Budget Office. The scoring will inform stakeholders how the plan could fit into the group's 2016 legislative efforts, Porter said. The proposal, dubbed the Bundled SNF-Stay Prospective Payment System, would would replace the existing prospective payment system, and move from a per diem model to a single episodic payment for an entire Part A SNF stay.

Additional legislative goals for 2016 include a renewed focus on the group's Quality Initiative, continuing work on observation stays where the NOTICE Act left off, and working with different stakeholder groups on arbitration issues.

“Frankly, of all of the rules that were promulgated or issued or proposed in the mega rule, the arbitration issue was the one that probably created the absolute most angst amongst our members,” Porter said. “We're hopeful, cautiously optimistic, that CMS has heard the concerns that we have.”