Put up-Acute Care ‘Meals Struggle’ Brewing in Washington

There’s a political meals combat brewing within the nation’s capital, well being care coverage insiders instructed Residence Well being Care Information.

And a doable overhaul to all the post-acute care (PAC) sector is in charge.

“One of many issues I’m listening to out of Washington is that there are some stakeholders within the post-acute care area all in favour of pushing for coverage that may delay a few of the [provisions] included within the IMPACT Act of 2014,” Lisa Grabert, a analysis professor at Georgetown and Marquette universities, instructed HHCN. “Particularly, there may be some motion on an try to get a delay of unified post-acute fee.”

The Bettering Medicare Put up-Acute Care Transformation (IMPACT) Act of 2014 was signed into legislation roughly 5 years. Broadly, the laws is supposed to create standardized information necessities for all PAC stakeholders, together with long-term Care Hospitals (LTCHs), expert nursing amenities (SNFs) dwelling well being businesses and others.

Along with uniform information constructions, the IMPACT Act additionally offered a timetable for a unified post-acute care fee mannequin. Particularly, the act calls on the Facilities for Medicare & Medicaid Companies (CMS) to suggest such a design earlier than 2024.

At the moment, LTCHs, SNFs and residential well being businesses are all reimbursed beneath setting-specific fee programs. A unified mannequin would change that, successfully paying all suppliers by means of a single, overarching framework. 

Whereas some have couched a unified fee mannequin as a pipe dream, others have stated it’s prone to occur sooner moderately than later.

“We’ve an actual future menace coming within the unified post-acute fee [mechanism],” April Anthony, CEO of Embody Well being’s (NYSE: EHC) dwelling well being and hospice phase, stated through the 2019 HHCN Summit. “I feel that would actually flip into the following [Patient-Driven Groupings Model] — and I feel it may occur ahead of PDGM even settles out.”

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The Medicare Fee Advisory Fee (MedPAC) — the entity charged with advising Congress on Medicare points — has been on the unified fee mannequin bandwagon for years. MedPAC final offered perception into what a theoretical unified fee mannequin would appear to be in June.

Based mostly on MedPac’s advisable method, SNFs seem to realize probably the most in a unified post-acute care fee system, with in-patient rehabilitation amenities (IRFs) shedding probably the most. The affect to dwelling well being suppliers would possible be someplace in between, relying on circumstances.

At the moment, it seems to be the facility-based suppliers main the cost on a delay, in line with Grabert.

“The push appears to be somewhat bit extra from the hospital-based aspect of post-acute care, so extra from the in-patient rehab amenities and the long-term care hospitals,” she stated. “And plainly they’re extra squarely within the camp of eager to see a delay for fairly a very long time, however which will create a little bit of a meals combat as a result of there could also be another stakeholders who see this as a giant alternative to realize new quantity and new revenues beneath Medicare not essentially obtainable to them up to now.”

Arguably, a delay of the unified fee mannequin is smart for a number of causes.

For starters, CMS nonetheless has a methods to go on a few of the unified-data facets of the IMPACT Act. On {top} of that, CMS already has its arms full with main fee reform within the SNF area with the Affected person-Pushed Fee Mannequin (PDPM) and within the dwelling well being area with PDGM.

“I feel that that has taken up numerous [CMS’s] effort and time internally,” stated Grabert, lead creator of PDGM. “And people items have been probably not contemplated when Congress initially mandated the IMPACT Act.”

{Clarity} surrounding the standing of a unified fee mannequin needs to be coming quickly.

On Nov. 18, CMS is ready to convene its second Technical Skilled Panel (TEP) to debate the way it would possibly finally proceed with the chance.

“They’ll be having their second massive assembly on that, which is adopted by an open request-for-information remark interval,” Grabert stated. “So, [policymakres] are going to be speaking about a few of the feedback they acquired from stakeholders and posing extra inquiries to the panel on how they will put collectively the unified system shifting ahead.”

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