Quicker start is possible for unified payments: MedPAC

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A unified method of reimbursing post-acute care could be a reality soon, experts say.
A unified method of reimbursing post-acute care could be a reality soon, experts say.

Thanks to the creation of models that would use data already collected by federal officials, post-acute providers could be using a unified Medicare payment system sooner than expected, officials say.

Current timetables envision a unified, site-neutral reimbursement system sometime after 2023. But several Medicare Payment Advisory Commission officials recently wrote there might not be a need to wait that long.

Long-term care providers generally favor a unified system, which would consolidate four separate PAC payment systems into one, because they feel they would become a more attractive option.

Average payments for most patient groups would be “reasonably accurate” without additional assessment data, wrote MedPAC principal analyst Carol Carter and colleagues Bowen Garrett and Douglas Wissoker in a Health Affairs Blog post. That could pave the way for early implementation of a unified plan.

However, CMS first would have to create a monitoring program that could detect “inappropriate” provider activity, such as choosing to treat more lucrative patients and not others, providing unnecessary post-acute care stays and delaying care.

Medicare officials also would need to readjust setting-specific policies, such as conditions of participation, once the system is in place, they noted.

Perhaps ominous for providers, the authors added that their analysis of 2013 data showed that Medicare payments averaged 19% “above the costs of PAC.” 

This suggests that “program payments for these services could be lowered,” they wrote.

About 40% of Medicare beneficiaries discharged from an acute-care hospital subsequently use nursing homes or other post-acute providers, the authors noted.