Federal agencies are touting a uniform payment program for the post-acute sector as one possible way to bolster competition and choice in healthcare, according to a new report.
The 119-page analysis, issued this week by Health and Human Services and the departments of Labor and Treasury, focused on ways to increase competition in healthcare. State Medicaid programs should “embrace site neutrality as a goal,” with an eye toward delivering value “defined according to a relatively limited, straightforward, and non-gameable set of metrics.”
“Metrics should not be designed and proposed solely by the entities to which they will ultimately apply,” the authors wrote.
The idea for unified payment across PAC settings has previously been endorsed by the Medicare Payment Advisory Commission. The American Health Care Association has supported payment transformation “that ensures adequate and appropriate payment “ for Medicare-financed post-acute care, Mike Cheek, senior vice president of reimbursement policy and legal affairs, told McKnight’s Wednesday.
SNFs stand to gain under site-neutral payments, although the industry objects to lumping together post-acute payments. Medicare paid about $60 billion for post-acute services in 2016, according to Monday’s report. Base prospective payment systems differ greatly among settings — at about $15,000 per discharge for inpatient rehab facilities, $400 per diem for SNFs (up to 100 days in a covered spell of illness), $3,000 per 60-day episode for home health agencies, and about $41,000 per discharge for a standard long-term care hospital stay.
“A unified or site-neutral PAC prospective payment system would base Medicare payment on the clinical characteristics of the patient instead of the provider setting,” the report states.
Cheek said AHCA is interested in MedPAC concepts that include “payment by stay and companion policies to address patients with intense needs who might benefit from a high cost outlier policy, and patients who might need more intense services but for a shorter length of stay. These patients likely would be best supported by a short-stay policy.”
McKnight’s reported last year that MedPAC members have been on board with an incremental shift to a new pay model starting in 2019.