AHCA: Unified payment plan 'viable' but 3-day stay part needs work

Share this content:

Recommendations to Congress concerning a unified, site-neutral payment system for post-acute care are viable, a leading provider group said Wednesday.

Mike Cheek, senior vice president for reimbursement with the American Healthcare Association, said his group appreciates the urgency with which the Medicare Payment Advisory Commission  endorsed a unified payment system. But he warned that any major payment reforms should be “carefully examined”

“Reforming the post-acute care sector specifically presents many risks but also opportunities for those providers to align with new hospital and physician payment systems,” Cheek said in a statement to McKnight's.

Cheek noted that the group found many of the elements of MedPAC's sprawling report to be promising, especially its discussion of a payment model based on episodes, not setting. Other provisions struck the group as not doing enough to “advance us further down the path of progress,” Cheek said.

One of those less-than-spectacular provisions is MedPAC's endorsement of the three-day hospital stay requirement for skilled nursing care. The commission called the recommendation an “important barrier” that prevents nursing homes from recertifying residents as Part A-covered in order to receive higher Medicare payments.

“If the hospital stay requirement is waived entirely, Medicare's liability for [post-acute care] could increase substantially,” MedPAC's report reads.

MedPAC previously recommended that two observation days count toward the three-day stay.

Despite its shortcomings, AHCA will provide input on MedPAC's plans to advance a site-neutral payment system, as well as subsequent IMPACT Act of 2014 reports, Cheek said.