Medicare payments would decrease for for-profit and freestanding providers under a proposal being considered by the Medicare Payment Advisory Commission designed to accelerate reimbursement adjustments.

Changes to pay formulas would begin as early as 2019 and proceed in incremental stages until 2021 under a MedPAC plan under consideration. Current pay rates would be blended with proposed ones from MedPAC’s site-neutral post-acute pay system to determine interim compensation.

Nonprofits and hospital-based providers would see increased pay rates, officials projected.

Commissioner David Grabowski, Ph.D., said the skilled nursing facility prospective payment system was handled similarly.

“My sense is that was a positive, and I think going here, in that same incremental fashion, could also be a positive, whether that’s kind of one-third in 2019 and then two-thirds in 2020 and then the full step in 2021.”

MedPAC was to resume discussion on this topic and others at its December meeting, which then leads into January voting.