Advertisement

Site-Neutral Payment for Postacute Care: Framing the Issue

  • Gerben DeJong
    Correspondence
    Corresponding Author Gerben DeJong, PhD, FACRM, MedStar National Rehabilitation Hospital, 102 Irving St NW, Washington, DC.
    Affiliations
    MedStar National Rehabilitation Hospital, Washington, DC; Georgetown University School of Medicine, Washington, DC; and MedStar Health Research Institute, Washington, DC
    Search for articles by this author
Published:March 06, 2014DOI:https://doi.org/10.1016/j.apmr.2014.02.018

      Abstract

      This commentary evaluates the merits of proposals in the United States to create a site-neutral payment system for postacute care for patients with select rehabilitation-related conditions. Under a site-neutral payment system, Medicare would pay providers based on patients' clinical needs, not on the peculiarities of individual postacute settings such as skilled nursing facilities and inpatient rehabilitation facilities. This commentary frames the policy choices by taking into account the research evidence on setting costs and outcomes, the policy tools and preconditions needed for an effective site-neutral payment system, and the overall direction of American health and postacute policy.

      Keywords

      List of abbreviations:

      IRF (inpatient rehabilitation facility), LTCH (long-term care hospital), SNF (skilled nursing facility)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. MedPAC June 2013 data book, chart 8-2, p 122. Available at: http://www.medpac.gov/documents/Jun13DataBookEntireReport.pdf. Accessed January 13, 2014.

      2. Pruit NJ Jr. Site neutral payment methodology and long term services and supports implications. White paper. Available at: http://www.ahcancal.org/facility_operations/medicare/Documents/Site%20Neutral%20Payment%20White%20Paper.pdf. Accessed January 14, 2014.

      3. American Medical Rehabilitation Providers Association. Ensure clinical appropriate care: oppose misguided site neutral payments proposal. Available at: http://www.amrpa.org/uploads/docuploads/Spring%20Meeting/Ensure%20Clinically%20Appropriate%20Care--%20Oppose%20Misguided%20Site%20Neutral%20Payments%20Proposal.pdf. Accessed January 17, 2014.

        • Black J.
        • Warren S.
        House Committee on Ways and Means issues draft legislative framework for reform of Medicare post-acute payments.
        AMRPA Magazine. 2013; 16: 22-24
      4. Kahn C. Letter to U.S. House of Representatives, House Ways and Means Committee, August 30, 2013. Available at: http://www.fah.org/fahCMS/Documents/Issues/Congressional%20Communications/2013/FAH_Ways_Means_PAC_Ltr.pdf. Accessed January 17, 2014.

      5. Pollack R. Letter from American Hospital Association to U.S. Senate Finance Committee and House Ways and Means Committee. August 13, 2013. Available at: http://www.aha.org/advocacy-issues/letter/2013/130819-let-aha-senate-finance.pdf. Accessed January 17, 2014.

        • Gage B.
        • Morley M.
        • Smith L.
        • et al.
        Post-acute payment reform demonstration: final report.
        Research Triangle Institute, Washington (DC)2012: 2-3 (Available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/Research-Reports-Items/PAC_Payment_Reform_Demo_Final.html. Accessed January 13, 2014)
        • Morley M.
        • Bogasky S.
        • Gage B.
        • Flood S.
        • Ingber M.
        Medicare post-acute care episodes and payment bundling.
        Medicare Medicaid Res Rev. 2014; 4 (Available at:) (Accessed January 25, 2014): E1-14
        • DeJong G.
        • Tian W.
        • Smout R.J.
        • et al.
        Use of rehabilitation and other health care services by patients with joint replacement after discharge from skilled nursing and inpatient rehabilitation facilities.
        Arch Phys Med Rehabil. 2009; 90: 1297-1305
      6. Gage B, Morley M, Constantine R, et al. Examining relationships in an integrated hospital system. Waltham: RTI International; 2008. Available at: http://aspe.hhs.gov/health/reports/08/examine/report.html. Accessed January 13, 2014.

      7. Kramer AM, Holthaus D, Goodrish G, Epstein A. A study of stroke post-acute care costs and outcomes: final report. Denver: University of Colorado, Health Sciences Center; 2006. A report prepared for the Office of Disability, Aging and Long-Term Care Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. Contract nos. HHS-100-97-0013 and HHS-100-00-0023. Available at: http://aspe.hhs.gov/daltcp/reports/2006/strokePAC.htm. Accessed January 14, 2014.

        • Newhouse J.
        • Garber A.
        • Graham R.
        • McCoy M.
        • Mancher M.
        • Kibria A.
        Variation in health care spending: target decision making, not geography. Institute of Medicine Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Health Care.
        The National Academies Pr, Washington (DC)2013 (Available at: http://www.nap.edu/catalog.php?record_id=18393. Accessed January 14, 2014. p 9-10, 65-70)
      8. Rau J. Medicare seeks to curb spending on post-hospital care. Washington Post 2013 Dec 1. Available at: http://www.washingtonpost.com/national/health-science/medicare-seeks-to-curb-spending-on-post-hospital-care/2013/12/01/04ddaa0c-5aa0-11e3-801f-1f90bf692c9b_story.html. Accessed January 13, 2014.

        • Buntin M.B.
        • Garten A.D.
        • Paddock S.
        • Saliba D.
        • Totten M.
        • Escarce J.J.
        How much is postacute care use affected by its availability?.
        Health Serv Res. 2005; 40: 413-434
        • Medicare Payment Advisory Commission (MedPAC)
        Approaches to bundling payment for post-acute care. Report to Congress: Medicare and the health care delivery system.
        MedPAC, Washington (DC)2013: 72 (http://www.medpac.gov/documents/Jun13_EntireReport.pdf. Accessed January 13, 2014)
        • Dejong G.
        • Horn S.D.
        • Smout R.J.
        • Tian W.
        • Putman K.
        • Gassaway J.
        Joint replacement rehabilitation outcomes on discharge from skilled nursing facilities and inpatient rehabilitation facilities.
        Arch Phys Med Rehabil. 2009; 90: 1284-1296
        • DeJong G.
        • Hsieh C.H.
        • Putman K.
        • Smout R.J.
        • Horn S.D.
        • Tian W.
        Physical therapy activities in stroke, knee arthroplasty, and traumatic brain injury rehabilitation: their variation, similarities, and association with functional outcomes.
        Phys Ther. 2011; 91: 1826-1837
        • Deutsch A.
        • Granger C.V.
        • Fiedler R.C.
        • et al.
        Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs for Medicare beneficiaries with hip fracture.
        Med Care. 2005; 43: 892-901
        • Kane R.L.
        • Chen Q.
        • Finch M.
        • Blewett L.
        • Burns R.
        • Moskowitz M.
        The optimal outcomes of post-hospital care under Medicare.
        Health Serv Res. 2000; 35: 615-661
        • Kramer A.M.
        • Steiner J.F.
        • Schlenker R.E.
        • et al.
        Outcomes and costs after hip fracture and stroke. A comparison of rehabilitation settings.
        JAMA. 1997; 277: 396-404
        • Munin M.C.
        • Seligman K.
        • Dew M.A.
        • et al.
        Effect of rehabilitation site on functional recovery after hip fracture.
        Arch Phys Med Rehabil. 2005; 86: 367-372
        • Walsh M.B.
        • Herbold J.
        Outcome after rehabilitation for total joint replacement at IRF and SNF: a case-controlled comparison.
        Am J Phys Med Rehabil. 2006; 85: 1-5
        • Horn S.D.
        • DeJong G.
        • Smout R.J.
        • Gassaway J.
        • James R.
        • Conroy B.
        Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better?.
        Arch Phys Med Rehabil. 2005; 86: S101-S114
        • Lieberman D.
        • Friger M.
        Inpatient rehabilitation outcome after hip fracture surgery in elderly patients: a prospective cohort study of 946 patients.
        Arch Phys Med Rehabil. 2006; 87: 167-171
        • Murtaugh C.M.
        • Peng T.
        • Aykan H.
        • Maduro G.
        Risk adjustment and public reporting on home health care.
        Health Care Financ Rev. 2007; 28: 77-94
        • Medicare Payment Advisory Commission (MedPAC)
        Report to Congress.
        MedPAC, Washington (DC)2011: 150-154 (Available at: http://www.medpac.gov/chapters/Mar11_Ch07.pdf. Accessed January 15, 2014)
        • Buntin M.B.
        • Colla C.H.
        • Deb P.
        • Sood N.
        • Escarce J.J.
        Medicare spending and outcomes after postacute care for stroke and hip fracture.
        Med Care. 2010; 48: 776-784
        • Chan L.
        • Sandel M.E.
        • Jette A.M.
        • et al.
        Does postacute care site matter? A longitudinal study assessing functional recovery after a stroke.
        Arch Phys Med Rehabil. 2013; 94: 622-629
        • Mallison T.
        • Deutsch A.
        • Bateman J.
        • et al.
        A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients following hip fracture repair.
        Arch Phys Med Rehabil. 2014; 95: 209-217
        • Tian W.
        • DeJong G.
        • Horn S.D.
        • Putman K.
        • Hsieh C.H.
        • DaVanzo J.E.
        Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility?.
        Med Decis Making. 2012; 32: 176-187
        • Haley S.M.
        • Coster W.J.
        • Andres P.L.
        • et al.
        Activity outcome measurement for postacute care.
        Med Care. 2004; 42: I49-I61
      9. Patient Protection and Affordable Care Act, Pub L No. 111–148, §3006-3007, §3013 §3021-022, §10308, §10326.

        • Berenson R.
        Moving payment from volume to value: what role for performance measurement.
        Urban Institute, Washington (DC)2010: 1-14 (Available at: http://www.urban.org/uploadedpdf/412344-moving-payment-volume-value-performance-measurement.pdf. Accessed January 13, 2014)
      10. Centers for Medicare and Medicaid Services. Bundled Payments for Care Improvement (BPCI) initiative: general information. Available at: http://innovation.cms.gov/initiatives/Bundled-Payments/index.html. Accessed January 16, 2014.

      11. Teles S. Kludgeocracy in America. National Affairs 2013;(17):97-114. Available at: http://www.nationalaffairs.com/publications/detail/kludgeocracy-in-america. Accessed January 14, 2014.