Friday Feature: MedPAC, Single Payment, and the IMPACT Act

The Medicare Payment Advisory Commission (MedPAC) via a report submitted to Congress on Thursday (yesterday) indicated that a single post-acute payment under Medicare is feasible but extensive policy procedural changes would be required to make it workable. The concept is that one uniform payment would apply to post-acute care delivered in home health, skilled nursing, long term care acute hospitals, and inpatient rehab facilities. The genesis of the single payment provision stems from a requirement within the IMPACT Act of 2014. For more information on the post-acute provisions within the Act, see my post here: https://wp.me/ptUlY-lx

In their 2021 report to Congress, MedPAC noted that value-based purchasing (VBP) was flawed as applied to SNFs. VBP was a key element within the IMPACT Act. The flaws are identified as the use of a single measure (hospital readmissions) combined with incentive payments too small to change behavior.

Single or unified payment systems are inherently complex when applied across inpatient and outpatient care. Inpatient care payments include elements of capital and equipment costs that are non-existent in home health. The concern with such payment approaches (unified) is that inpatient providers may be underpaid and potentially, home health, overpaid.

MedPAC notes that achieving a unified payment plan, while feasible, will require significant, complex policy overhauls such that the same, will change Medicare benefit and coverage rules and cost-sharing levels to assure one setting is not favored against another. Likewise, a new incentive system would have to be created to replace or revamp, VBP for post-acute care. Today, measures are different as are incentives between providers.

No recommendations regarding the single payment were made within the report to Congress. I suspect CMS will continue its work on the post-acute uniform payment plan without any formality forthcoming as the same will have to come with proposed policy changes that would take years to implement and measure.

The report (MedPAC) to Congress is available here: Jun23_MedPAC_Report_To_Congress_SEC

 


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