The Centers for Medicare & Medicaid Services announced last week that it will begin recruiting for its post acute care payment reform demonstration to improve payments and incentives in the PAC setting.
The agency said the project will be used to gather recommendations on how to improve payment for PAC services, including aligning incentives for treating patients seen across more than one PAC setting.
CMS also said it will use the demonstration to explore discharge patterns and outcomes between settings.
"This demonstration is an important and exciting CMS initiative," a CMS statement said. "It will give CMS and Medicare-participating providers better information on the case-mix severity of Medicare beneficiaries using their services. Adopting techniques that provide greater uniformity in how patients are assessed and quality is measured will allow CMS to improve PAC payments."
The announcement has some feeling skeptical. Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, Inc. in Washington said he has concerns about the post-acute demonstration, "despite its neutral description in the law."
"The demonstration may result in shifting costs from Medicare to other payers, including beneficiaries themselves, if it considers only costs and savings to the Medicare program, rather than the total costs to all payers of post-acute care," Edelman said.
Edelman said the demonstration may also lead to the elimination of post-acute settings that are viewed as more expensive, such as inpatient rehabilitation facilities, even when beneficiary outcomes are better than in less expensive settings, such as skilled nursing facilities, and even when the actual costs of the full episodes of care are comparable.
The demonstration could also eliminate or sharply reduce beneficiaries' right to choose among all qualified post-acute providers, said Edelman.
"CMS appears to have pre-judged the demonstration's findings when it announced, through its Policy Council's "Post Acute-Care Reform Plan" (Sept. 2006), that it wants to eliminate 'the excessive difference in payment' between inpatient rehabilitation facilities and skilled nursing facilities, Edelman said.
CMS said it plans to invite acute care hospitals, long term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies to voluntarily participate and it will attempt to recruit a representative sample of PAC services from across the country. Final selection of provider participants will be announced this fall.