Invited commentary| Volume 95, ISSUE 6, P1212-1216, June 2014

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Site-Neutral Payment for Postacute Care: Framing the Issue

  • Gerben DeJong
    Corresponding Author Gerben DeJong, PhD, FACRM, MedStar National Rehabilitation Hospital, 102 Irving St NW, Washington, DC.
    MedStar National Rehabilitation Hospital, Washington, DC; Georgetown University School of Medicine, Washington, DC; and MedStar Health Research Institute, Washington, DC
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Published:March 06, 2014DOI:


      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.


      List of abbreviations:

      IRF (inpatient rehabilitation facility), LTCH (long-term care hospital), SNF (skilled nursing facility)
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