MedPAC recommends reforming Medicare payment system for skilled nursing facilities

Fifty-four percent of the therapy nursing that homes billed to Medicare in 2013 was at the “Ultra High” level, up from just 7% in 2002, a prominent story in the Wall Street Journal reported on Monday.

Nursing home patients who receive Ultra High therapy — at least 720 minutes per week — generate some of the highest payments from Medicare, notes the WSJ analysis of billing records. In 2013, the average rate for ultrahigh therapy was $560 per day, contrasted by a rate of $445 for “Very High” therapy — 500 to 719 minutes per week. The lowest category of therapy, 45 to 149 minutes per week, paid an average rate of $325 per day.

The report traces the increase in Ultra High therapy billing to payment rule changes adopted by Medicare in 1998, and implemented over the following years, culminating over the past several years. The WSJ report is seen by many as another damning brick against opportunistic providers, who, naturally, see it otherwise.

The new rules “changed the incentives, which changed the culture,” said Vincent Mor, a Brown University health-services professor and chairman of the quality committee at HCR ManorCare Inc., to the Wall Street Journal. “Playing to the max has a long tradition in healthcare.”

The report cites evidence that therapy can help improve residents’ walking, talking and everyday tasks, but notes there’s no research showing that more therapy leads to greater outcomes. More than two dozen former therapists, rehabilitation directors and other nursing home employees reported to the Wall Street Journal that they felt pressure from their managers to reach the 720-minute Ultra High therapy level.

To read the Wall Street Journal’s full report, click here.