In its June Report to Congress on long-term policy goals, the Medicare Payment Advisory Commission (MedPAC) touched on important issues for long term and post-acute care providers (PACs), including sequential stays in a unified PAC system, encouraging use of high-quality PAC providers, and the structure of accountable care organizations (ACOs), among other items, according to Provider.
On the first topic of paying for sequential stays in a unified prospective payment system (PPS) for PAC, the commission presented the foundation for the move to the new-style payment model. Currently, Medicare uses separate PPSs to pay for stays in the PAC settings: skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities, and long term care hospitals.
MedPAC said this system results in Medicare’s fee-for-service payments varying greatly from setting to setting. To remedy the situation, and meet a congressional mandate, the commission developed a prototype design and estimated the impacts of a unified PAC PPS, which it believes is a feasible way to uniformly base PAC payments on patient characteristics and not where the care takes place.
To further the unified PAC PPS model, in the June report the commission examined two payment issues that it said would increase the accuracy of payments for cases that involve a course of PAC, or sequential stays.
The first of the two issues looks at the way the cost of a PAC stay can vary, depending on where it falls in a sequence of PAC stays. The second issue considers how to identify, for payment purposes, distinct phases of care for a PAC provider that treats a patient “in place” as care needs evolve.
The commission stressed that a unified PAC PPS requires a way to trigger payments for different phases of care so that such providers are not financially disadvantaged.
Read the full story at Provider.