MedPAC will recommend site-neutral payments, but not for strokes

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MedPAC will recommend site-neutral payments, but not for strokes
MedPAC will recommend site-neutral payments, but not for strokes

The Medicare Payment Advisory Commission is preparing to recommend that skilled nursing facilities and inpatient rehabilitation facilities receive equal reimbursement for 17 conditions, the panel's chairman announced at a meeting Friday.

MedPAC's June report to Congress proposed equalizing Medicare payments for services related to major joint replacement and hip/femur procedures, as well as post-stroke rehab. Analysts have since looked at 17 additional conditions for site-neutral payments, and commissioners discussed these at the latest meeting in Washington, D.C. They include orthopedic, cardiac and  pulmonary conditions.

Based on that discussion, outgoing chairman Glenn Hackbarth determined that there is a “pretty strong consensus” in favor of the site-neutral policy for these conditions. A draft recommendation focused on those 17, plus the previously discussed orthopedic conditions, will be considered at the next MedPAC meeting.

The draft recommendation will not include post-stroke services, Hackbarth decided. Commissioners were divided on whether site-neutral payments would be effective, given how variable the needs of this patient population are.

Stroke patients often receive services not only in IRFs and SNFs, but through home health and other providers, noted Commissioner Kathy Buto. This makes stroke care a prime candidate to be reimbursed through a post-acute bundle rather than simply through site-neutral payments, she argued. Hackbarth agreed.

Site-neutral payments theoretically would reduce Medicare spending. Proponents, including the American Health Care Association/National Center for Assisted Living, say that both types of providers offer similar care and have comparably good patient outcomes. Rehab provider advocates disagree.

“We encourage Congress to challenge MedPAC's recommendation to push patients into a less capable care setting that produces poorer outcomes because it is the cheapest option,” stated Bruce M. Gans, M.D., chairman of the American Medical Rehabilitation Providers Association.

Click here for a complete transcript of the MedPAC meeting. The group advises Congress on Medicare policy, but lawmakers are not obligated to follow its recommendations.