MedPAC wants mechanism to send patients to higher-quality, post-acute care

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The Medicare Payment Advisory Commission is struggling with how to help acute-care providers direct patients to better quality post-acute care.

During their public meeting March 1, commissioners debated a staff report outlining three possible mechanisms to improve information flow from hospital discharge planners to Medicare recipients.

Though those planners cannot recommend specific settings for recovery, the IMPACT Act requires that they use quality data in the discharge process. Still, no regulations outline how that new requirement should be implemented.

“PAC [post-acute care] use is frequent and costly, and we need to ensure, for the sake of the program and its beneficiaries, that we maximize the value of the dollars we spend on these services,” said analyst Evan Christman, according to a meeting transcript. “This has real consequences for beneficiaries, as those served by low-quality providers will have more hospitalizations and likely have worse clinical outcomes.”

 The three proposals debated by MedPAC included:

  • a flexible option allowing hospitals to define their own quality measures and performance levels to produce a list of high-quality providers to be shared with patients
  • a prescriptive option requiring use of Medicare-defined quality measures and performance levels, in which CMS notifies hospitals and beneficiaries of local, qualifying post-acute providers
  • a revised prescriptive option that accounts for ranges in quality across geographic markets or segments, with possible Medicare-provided rankings.

Several members want to get more useful information to patients and family members, whose input may weigh more heavily than already publicly available data.

“We've had such concern about hospitals steering patients to particular providers that we ended up having these beneficiaries make poor choices due to a lack of information,” said David Grabowski, Ph.D.

The panel is expected to discuss the issue further in June.