Providers wary of pay, care coordination aspects of chronic care proposal

The policies target chronic conditions like dementia, heart disease and diabetes
The policies target chronic conditions like dementia, heart disease and diabetes

A set of proposed policies for chronic care may have “unintended consequences” on payment systems and create barriers to care coordination, say provider groups.

In its comments to the Senate working group, the American Health Care Association on Monday urged the group to bear in mind the “unintended consequences” the policies could have on existing payment systems and access to care. AHCA also expressed concerns that proposed policies that link payment to community-level quality measures may take control from providers and put them at odds with residents' personal health wishes.

"This issue is of vital importance to AHCA/NCAL, since a majority of the individuals our members care for have multiple chronic medical conditions — and the number is growing rapidly," said Clifton Porter II, senior vice president of government relations for AHCA, in a statement.

The proposed policies, released in December by the Senate Finance Committee's Chronic Care Working Group, target treatment for Medicare beneficiaries with multiple chronic conditions, including diabetes, heart disease and dementia. The policy initiatives include providing hospice benefits to Medicare Advantage enrollees and expanding home care models.

Porter noted the that Medicare spending for beneficiaries with chronic conditions tops $300 billion each year. Spending for people with six or more conditions is three times higher than spending on average beneficiaries.

AHCA also recommended the working group distinguish between the “very different” populations of beneficiaries with several chronic conditions and those with one or two.

The American Hospital Association also responded to the working group's request for feedback with a letter sent last Tuesday. AHA urged the group to waive barriers to care coordination as it moves forward, including the “three-day rule” for skilled nursing facilities.

“Allowing healthcare providers maximum flexibility to identify and place beneficiaries in the clinical setting that best serves their short- and long-term recovery goals is essential to ensuring that care is provided in the right place at the right time — an important goal for all beneficiaries, but perhaps even more so for those who are chronically ill,” the group's comments read.

AHA also stressed the importance of expanding telehealth coverage in order to provide Medicare beneficiaries with better access to services to help treat and manage their chronic conditions.