WASHINGTON – The Centers for Medicare and Medicaid Services last month announced payment rates for the nation’s facilities that treat Medicare beneficaries for extended periods of time.
Announced reductions in payments to skilled nursing facilities drew swift industry response, with some saying the reductions will undercut the ability of SNFs to care for higher acuity patients.
In its announcement on SNF rates, CMS officials said they intend to recalibrate case-mix rates “to re-establish budget neutrality on a prospective basis.” They say the refinements made in case-mix indices in 2006 to better account for resources used in the care of medically complex patients resulted in more patients being classified into categories that resulted in higher-than-projected Medicare payments.
CMS also wants to readjust the amount paid to compensate for the use of non-therapy ancillary services by SNFs.
“Payments going forward would reflect the intent of the refinements, and payments to providers would more accurately and better reflect the service needs of Medicare beneficiaries,” CMS officials said. A better baseline would give the agency more leeway to implement changes to reward quality care and changes in industry practice.
CMS officials estimate the proposed recalibration for fiscal year 2009, which begins October 1, would result in a reduction in payments to nursing homes of $770 million, or 3.3 percent, but the reduction would largely be offset by a proposed increase of 3.1 percent in Medicare payment rates to SNFs, amounting to $710 million.
“We are confident that with the payment rates we are proposing today, the nation’s skilled nursing facilities would be able to continue to provide high-quality services to those who need critical skilled nursing facility care services,” said Kerry Weems, acting administrator at CMS.
Organizations representing SNFs were having none of that argument, They said the payment reductions were being underestimated and would have a significant negative impact.
The American Health Care Association and the Alliance for Quality Nursing Home Care issued a joint statement suggesting that the cuts would have “the net effect of cutting SNF payments by approximately $5 billion over five years,” said Bruce Yarwood, AHCA’s president and CEO.
“The policy we are currently following, as intended by existing law, improves our ability to care for a higher acuity patient population,” he said. “The CMS changes ... give with one hand and take away with another, leaving frail and elderly seniors in greater jeopardy.”
“Regulatory-driven budget cuts like those incorporated into the CMS rule would inhibit skilled nursing facilities’ ability to continue caring for increased numbers of high-acuity patients and undermine our ongoing efforts to invest in and build the necessary clinical infrastructure to ensure care quality is maximized,” said Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care.
Public comments on the proposed rule will be accepted until June 30.