Rehab groups disappointed in MedPAC recommendation

Two groups representing rehabilitation providers are expressing disappointment in the Medicare Payment Advisory Commission’s (MedPAC’s) “Report to Congress: Medicare Payment Policy for Medicare” [PDF], which recommends providing skilled nursing facility (SNF)-level reimbursement for individuals with certain conditions receiving rehabilitation at inpatient rehabilitation hospitals and SNFs. The policy would be effective next year and would be phased in over a three-year period.

“MedPAC’s site-neutral payment recommendation could put vulnerable patients at risk of being diverted from the coordinated, intensive inpatient care provided by medical rehabilitation hospitals and units to less regulated care provided in nursing homes,” American Medical Rehabilitation Providers Association (AMRPA) Chairman Bruce M. Gans, MD, said in a statement. “It is based on a mistaken belief that rehabilitation hospitals and nursing homes provide comparable care and produce comparable outcomes.”

Gans said that nursing homes can provide effective care but that reimbursement decisions must be made on a case-by-case basis and not be guided by cost. AMRPA has posted its concerns with MedPAC's recommendations on its website [PDF].

Another group, the Coalition to Preserve Rehabilitation (CPR), which represents consumer, disability and clinician organizations, also expressed concerns over the report. CPR said the recommendations, if followed, will inappropriately divert some people based on diagnosis alone and not on their individual, medical or rehabilitation needs.

“By adopting SNF rates for what is actually a higher, hospital level-of-care, this policy would create a strong financial disincentive to serve certain patients,” Judy Stein, executive director of the Center for Medicare Advocacy and a CPR Steering Committee member, said in a statement. “This will inevitably lead to access problems for medically complex patients who require an intensive, coordinated level of rehabilitation with the 24-hour availability of physicians. This level of care is simply not available in SNFs.”

CPR is asking Congress to wait to implement site-neutral payments until post-acute data from multiple settings are available for analysis as mandated by the Improving Medicare Post-Acute Care Transformation Act.

The MedPAC report also presents recommendations for 2016 rate adjustments in fee-for-service Medicare, payment models for primary care, Medicare Advantage plans and Medicare Part D.