House, Senate Leaders Introduce Bill To Change Post-Acute Care System

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June 26 — Leaders of the Senate Finance and House Ways and Means committees June 26 introduced bipartisan legislation (H.R. 4994, S. 2553) they said would strengthen and improve Medicare's post-acute care system.  

The proposed Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) would require data standardization to allow Medicare to compare quality across different post-acute care settings and improve hospital and post-acute care discharge planning, according to a joint committee release.

This information then would be used to alter the post-acute payment system via a new site-neutral or bundled payment system, or other changes, the release said.

“Without the comparable data required under the legislation, policymakers and providers cannot determine whether patients treated and the care provided in different settings is, in fact, the same or whether one [post-acute care] setting is more appropriate. Absent this information, it is difficult to move forward with [post-acute care] payment reforms,” it added.

The legislation was introduced by Finance Committee Chairman Ron Wyden (D-Ore.) and ranking member Orrin G. Hatch (R-Utah), along with House Ways and Means Chairman Dave Camp (R-Mich.) and ranking member Sander M. Levin (D-Mich.).

The legislation follows the release of a discussion draft in March that was largely based on input the lawmakers received from post-acute care stakeholders.

Post-acute care includes long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies.

Wide Variation in Utilization

The lawmakers say the changes will help Medicare patients receive the right high-quality post-acute care in the right setting at the right time.

“The problems with the status quo are clear, as multiple analyses spotlight the wide variation in utilization in all sectors of Medicare post-acute care, as well as vast differences in Medicare and all-payer margins among providers,” a summary of the bill said.

“The substantial variation in spending, quality, and margins within the post-acute sector provides strong motivation for modernizing this sector,” it said. “Payment reform ideas include expansion of bundled payments, site neutral payments, and value based purchasing.”

The bill would build on existing post-acute care assessment tools and require the reporting of common data across providers for purposes of patient assessment, quality comparisons, resource use measurement and payment reform, according to the summary. Post-acute care providers would begin reporting such information in 2019, it said.

The legislation also would require the Department of Health and Human Services and the Medicare Payment Advisory Commission to report to Congress by 2022 on new post-acute payment models, the summary said.

The bill also would direct the HHS to develop regulations encouraging the use of quality data in patient discharge planning while continuing to take into account patient preferences, the summary said. It would require providers to begin using quality data in their patient discharge planning process by 2016.

A summary of the bill is at A section-by section outline is at