Medicare payment changes for nursing homes and home health agencies aren’t on lawmakers’ radar screens, in spite of congressional advisers’ recommendations.
The Medicare Payment Advisory Commission, the main adviser to Congress on Medicare payment policies, said in its annual June report that a unified payment system for post-acute care should start in 2021. A unified system would base Medicare payments for nursing homes and home health agencies on patient characteristics instead of the setting where the care is provided. The proposal has received praise and raised concern, but health-care stakeholders said Congress is unlikely to take up the recommendations anytime soon.
“I’m not sure [the proposal] has the political will at this point,” Erica Breese, senior manager at Avalere Health, a health-care consulting company in Washington, told me June 21. “It’s way too big and too controversial for them to take on right now.”
In its June 2016 report, MedPAC said the unified payment system could be implemented sooner than the 2024 timetable outlined in the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The IMPACT Act requires reports on a post-acute care prospective payment system but doesn’t mandate the implementation of a unified prospective payment system. Only Congress can implement such changes.
Joy Cameron, vice president of policy and innovation at the Visiting Nurse Associations of America in Arlington, Va., told me MedPAC continues to make recommendations that Congress has ignored and that lawmakers have shown little interest in taking up the post-acute payment reforms.
“Often Congress reads the report and goes their own way,” she told me June 20. “The unified payment isn’t going to get much traction in Congress, especially the earlier timeline. I don’t know if it is a lack of interest, or if their plates are full.”
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