Post-acute payment reform draws AHA ire

The American Hospital Association on Friday urged the House Ways and Means Health Subcommittee to reject Medicare payment reforms that would further cut payments to long-term care hospital (LTCHs), inpatient rehabilitation facilities (IRFs), skill nursing facilities (SNFs) and home health agencies (HHAs).

Many of the proposals discussed during the hearing by Jonathan Blum, director of the Center for Medicare, are "arbitrary cuts that would threaten patients' access to post-acute care services," the AHA said in a statement submitted for the hearing.

The proposals, including several in the administration's 2014 budget, come from the Centers for Medicare & Medicaid Services and the Medicare Payment Advisory Commission (MedPAC).

"We are deeply concerned that the commission has not adequately justified the need for such extreme reforms, especially considering how drastically they differ from its prior goal of using criteria to define the type of patient who is appropriate for admission to an LTCH," AHA said in the statement.  "Rather than continuing on this radical path toward elimination of the LTCH PPS (prospective payment system), we urge consideration of more reasonable reforms that would maintain the LTCH PPS for a narrower range of appropriate cases."

In his testimony, Blum said the proposed payment changes are intended to better manage Medicare spending on post-acute care. Spending varies significantly by geography, he said, and greater spending "does not appear to be associated with better healthcare outcomes."

In addition to the payment changes, CMS is working to develop new models including bundled payments and accountable care organizations to better manage post-acute-care spending.

In separate testimony, Mark Miller, Ph.D., executive director of MedPAC, said post-acute care is ill-defined, with different care settings providing similar services that are reimbursed at different rates depending on the setting.

"Medicare's rules and clinical evidence do not clearly delineate the types of patients who belong in each setting and the amount of service needed," Miller said. "The use of outpatient therapy is similarly vexed by the lack of guidelines about when and how much therapy is appropriate for a given condition."

Among the payment changes highlighted in Blum's testimony, CMS plans to change how payments for home healthcare are calculated, revise payments for hospice care, require better documentation of rehabilitation therapy sessions, change payment rates for inpatient hospitals with rehabilitation facilities, revise rates for long-term care hospitals that receive more than 25 percent of their patients from a single acute-care facility, and update quality measures tied to payments.

For more:
- read the AHA statement (.pdf)
- download Blum's testimony (.pdf)
- check out Miller's testimony (.pdf)