NAHC: MedPAC Delays Consideration Of Including Hospice In Post-Acute Transfer Policy

The Medicare Payment Advisory Commission (MedPAC) has recently been examining hospitals’ increased use of “observation status” and its effects on beneficiaries and other stakeholders. MedPAC has referenced possible policy changes that could help offset increased costs resulting from hospital short-stay policy recommendations. One of the options under consideration that was discussed was the expansion of the post-acute hospital transfer policy to include “early” discharges to hospice care. The extension of the post-acute transfer policy to include hospice was examined by HHS and the OIG in a May report. Click here to see it.

In its March meeting, MedPAC indicated that rather than considering a recommendation on including hospice in the post-acute transfer policy at this time, it instead intends to explore the issue in more depth as part of future meetings before issuing a recommendation.

NAHC has expressed concern about extension of the post-acute transfer policy to hospice in its discussions with MedPAC. NAHC believes that election of hospice care represents a decision to forego curative care, and that post-acute care discharge to hospice represents a “shift in focus of treatment” that would create a financial incentive for hospitals to retain patients on care. Click here to read NAHC’s full letter to MedPAC.

Click here to read more from NAHC.

SNFs Could Soon Share Responsibility For Hospital Readmissions

According to the Medicare Payment Advisory Commission (MedPAC), approximately 14% of Medicare patients discharged from hospitals to skilled nursing facilities (SNFs) are rehospitalized for conditions that potentially could have been avoided.  As a result, SNFs could soon share responsibility with hospitals for avoidable readmissions.

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MedPAC: Medicare Should Reduce SNF Payments 4%

In a recent report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended Medicare payments to skilled nursing facilities should be cut 4% in 2014 and steadily reduced in subsequent years. The council also advised a decrease in rates to achieve $10 billion in savings by 2018.

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MedPAC 2013 Recommendations Finalized

Last week, the Medicare Payment Advisory Commission (MedPAC) met to finalize its 2013 Medicare recommendations to Congress. MedPAC reiterated its 2012 recommendations including the following:

  • The U.S. Department of Health and Human Services (HHS) should conduct medical review activities in the counties that show aberrant home health utilization. Payment and enrollment of new providers should be suspended if they indicate significant fraud.
  • Congress should direct HHS to begin a two-year rebasing of home health rates and eliminate the market basket increase.
  • A revision to the home health case mix system to rely on patient characteristics should be made to set payments for therapy and non-therapy services and should no longer use the number of therapy visits as a payment factor.
  • Congress should direct HHS to establish a per-episode copayment for HH episodes not proceeded by hospitalization or post acute care use.

MedPAC noted concerns over the upcoming Jimmo v. Sebelius legal settlement and its implications on higher utilization. Because of the settlement, the Obama administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services. As a result of their concerns, MedPAC believes that a compressed rebasing would be beneficial to eliminating higher utilization before the settlement goes into effect. Estimates show that the Medicare program will save $5-10 billion over a decade because of rebasing.

Medpac Issues Medicare Report To Congress

The Program of All-Inclusive Care for the Elderly (PACE) providers should be paid more generous Medicare Advantage rates, according to the Medicare Payment Advisory Commission (Medpac).  The panel also called for changes that would allow people younger than age 55 to participate in the program, which targets dual-eligible seniors.

In a report to Congress earlier this month, the commission said PACE spending is actually higher than if beneficiaries had remained in traditional fee-for-service programs. In the past, PACE has been shown to reduce hospitalizations and nursing home stays among dually eligible Medicare and Medicaid beneficiaries, but it’s currently experiencing lower than projected enrollment rates. The demonstration program was enacted to give nursing home eligible populations a community-based option for long-term care services.

The commission’s semi-annual report to Congress has two general goals: preventing unexpectedly high out-of-pocket costs for beneficiaries, and creating incentives that encourage beneficiaries to make better decisions about healthcare services.

To read Medpac’s recommendations to Congress, click here.