Specifics of payment policy should 'come later,' MedPAC commissioners say

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MedPAC Chairman Glenn Hackbarth
MedPAC Chairman Glenn Hackbarth

Skilled nursing facilities and other stakeholders should be able to weigh in on which conditions to include in a site-neutral payment policy, members of the Medicare Payment Advisory Commission said during a meeting Friday.

For months, MedPAC has been discussing a policy that would equalize reimbursements for skilled nursing facilities and inpatient rehabilitation facilities, for certain conditions. Commissioners repeatedly have indicated they likely will issue a formal recommendation to Congress in favor of the policy. At its meeting last week, MedPAC discussed in greater detail how to compose the recommendation.

They debated whether the recommendation should name the specific conditions that would be reimbursed at equal levels. The group has been analyzing 22, such as therapy after joint replacement. However, Chairman Glenn Hackbarth and other members said the recommendation could float potential conditions but should seek mainly to encourage discussion.

“In some sense, we don't actually have a strong view on exactly which [conditions] should be in and which ones shouldn't,” said Commissioner Katherine Baicker, Ph.D., of the Harvard School of Public Health. Leaving specific conditions out of the recommendation would clarify that “the recommendation doesn't hinge on specific conditions,” and would help encourage “lots of comment and dialogue,” she said.

The commission will formally vote on the recommendation at its Jan. 15-16 meeting. Skilled nursing providers back the proposal. Inpatient rehab facilities — which stand to see reimbursements reduced —  have protested it, as have some consumer advocacy groups. They argue that IRFs and SNFs serve fundamentally different types of patients and should not be considered interchangeable from a payment perspective.

Click here for a full transcript of MedPAC's Dec. 18-19 meeting in Washington, D.C.