Skilled nursing providers and inpatient rehab facilities offer clashing views on Medicare payments

AHCA site-neutral comments

Proposed Medicare payment changes have put the nation’s largest long-term care association at odds with inpatient rehabilitation providers, and the two sides sought to sway legislators in advance of a Congressional hearing Wednesday.

Federal lawmakers should take necessary steps so that skilled nursing facilities and inpatient rehabilitation centers are reimbursed at the same level for some services, the American Health Care Association/National Center for Assisted Living urged in written testimony to the House Committee on Ways and Means. The committee held a hearing yesterday with Mark Miller, executive director of the Medicare Payment Advisory Commission, on the group’s recent Congressional report.

MedPAC offered a framework for implementing “site-neutral” post-acute payments in its report. Legislators should implement the proposal, which would equalize payments for certain orthopedic conditions, AHCA/NCAL stated in its six-page testimony. The association also urged Congress to pass a drafted bill that would lead to a standardized assessment tool for post-acute providers, allowing for the cross-setting comparisons needed to expand site-neutral payments.

AHCA believes that site-neutral payments would improve care and efficiency by tying reimbursement to patient needs rather than setting. The trade organization representing inpatient rehabilitation facilities — whose reimbursements would shrink under a site-neutral policy — disagrees.

MedPAC’s proposal would hurt patients by pushing them into the “less capable” SNF setting because it is the “cheapest option,” stated Bruce M. Gans, M.D., chairman of the American Medical Rehabilitation Providers Association.

IRFs must meet higher staffing standards than nursing facilities and admit patients that can sustain a high level of therapy, AMRPA noted. Inpatient rehab providers achieve better patient outcomes in less time than SNFs, Gans said, citing a recent study. The two provider types treat similar patients and achieve comparable outcomes, according to MedPAC’s report.

Gans urged legislators at the Ways and Means hearing to “push back” against MedPAC.

Committee member Rep. Tom Price, M.D. (R-GA) questioned whether the Centers for Medicare & Medicaid Services has weighed in. CMS is aware of the issue, Miller said, but MedPAC has not “gotten feedback in terms of way to go [or] stop what you’re doing.”

MedPAC has not issued a formal recommendation regarding site-neutral payments, despite presenting a case for it in the June report, Miller emphasized. If the plan goes forward, IRF regulations should be relaxed to even the playing field with SNFs, the report stated.