Provider advocates returned fire on Monday, after the group of experts, which advises Congress on Medicare policy, said future pay bumps for skilled nursing should be nixed.
The Medicare Payment Advisory Commission first criticized some of the new policies that are favored by the skilled care sector in a comment letter to the federal government issued Friday. That letter came in response to the Centers for Medicare & Medicaid Services’ new Patient-Driven Payment Model, which was announced back in April.
In Friday’s letter, MedPAC Chairman Francis Crosson, M.D., argued that skilled nursing should not be in line to receive a 2.4% pay increase, as spelled out in a proposed market basket update. That increase seems unnecessary, he argues, with SNFs earning an aggregate Medicare margin of about 11.4% — a “high level” that is “more than adequate to accommodate cost growth.”
A LeadingAge official took umbrage with some of those assertions on Monday, saying in a subsequent statement that MedPAC’s recommendations, if implemented, “could be particularly detrimental to our members.” Nicole Fallon, VP of health policy and integrated services, noted that nonprofits earn just 2.3% on Medicare, compared to 14% on the for-profit side. Plus, MedPAC’s analysis only focused on Medicare, she argued, and does not take into account Medicaid, upon which many of its members also rely.
“Failing to provide sufficient reimbursement places access to these services in jeopardy and denying an increase across the board as MedPAC suggests doesn’t acknowledge the inherent differences in how these nursing facilities operate,” she told McKnight’s.
“Our members provide services until they can’t any more, at which point they shut their doors or get sold off to large chains. MedPAC’s criteria are not optimal for ascertaining the appropriate value of services our members provide,” she added.
MedPAC’s letter goes into further detail on several other points tied to the proposed Patient Driven Payment Model (PDPM). Among them, the Commission supports the redesigned case-mix classification system but remains disappointed about talk of delaying proposed changes until fiscal 2020.
“Providers should already be well aware of the key design features of the proposal. The postponement will delay the much-needed redistribution of payments away from therapy-driven care and toward medically complex care,” Crosson wrote.
Also on Friday, MedPAC released its June report to Congress, a brief summary of which can be found here.