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Congress eyes acute care-LTC handoff

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Care providers are pushing back against an effort in Congress to change the way Medicare pays for post-acute care.

Three lawmakers — Reps. Dave McKinley, R-W.Va.; Tom Price, R-Ga.; and Jerry McNerney, D-Calif. — have introduced H.R. 1458, the Building and Coordinating Post-Acute Care (BACPAC) Act of 2015 bill. 

The bill would let Medicare create a system for paying for bundles of post-acute care services, such as stays in long-term acute care hospitals and skilled nursing facilities, rather than paying for each service provided separately.

The bill would direct the secretary of the U.S. Department of Health and Human Services (HHS) to report by 2020 on the feasibility of Medicare bundling all acute inpatient hospital care services with post-acute care services.

The House Energy & Commerce health subcommittee held a hearing on Medicare post-acute care reimbursement Thursday, and witnesses said Congress should take its time before making any changes in the reimbursement rules.

Dr. Samuel Hammerman, chief medical officer for long-term acute care hospitals at Select Medical Corp., testified that the BACPAC bill is vague on many provisions and would undercut clearer, possibly better Medicare reimbursement provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA), and in the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, a law that fleshed out PPACA Medicare reimbursement provisions.

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Hammerman told lawmakers that only about 10 percent of Medicare is related to post-acute care, and that early Medicare reformers encouraged use of post-acute care in an effort to hold down Medicare hospital spending.

Expansion of post-acute care use has helped cut the average length of a hospital stay to five days, from three weeks, Hammerman said, according to a written version of his testimony posted on the committee website.

A poorly designed bundled payment program “provides incentives to reduce not only unnecessary care, but also necessary care,” Hammerman said.

Another witness, Leonard Russ, chair of the board of the American Health Care Association, who is the co-owner of a nursing home, said post-acute care providers are already participating in a Bundled Payments for Care Improvement (BPCI) test program organized by the Centers for Medicare & Medicaid Services (CMS).

Shifting to bundled payments has been extremely difficult for the providers, Russ said.

Simply classifying patients is difficult, and, because a typical facility treats only a small number of patients in many the risk categories used, the facility faces the threat that taking in a few patients with unusual, catastrophic health problems will expose the facility to “outlier risks,” Russ said.

Russ urged Congress to start by assuming that, for now, at least, Medicare must keep hospital care payment bundling and post-acute payment care bundling separate.

“There is strong evidence demonstrating that the acute care delivered to patients does not directly correlate to, nor can it predict, the costs and patterns of the post-acute care that subsequently will be needed,” Russ said.

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