MedPAC June Report to Congress: Hospice Payment Reform, Post-Acute Bundling and Duals
Tuesday, June 18, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy

On June 14, the Medicare Payment Advisory Commission (MedPAC) released its June 2013 Report to Congress which examines cross-cutting payment issues and potential changes to the Medicare program.   

In a chapter on hospice, MedPAC reports that their recent study of payment supports earlier recommendations that payment follow a U-shaped pattern with higher reimbursement at the beginning and end of an episode and lower payments in the middle.  

MedPAC notes that additional administrative controls are necessary including scrutiny of hospice live discharges and payment for hospice in nursing facilities. On live discharges, 18 percent of the 1.2 million hospice episodes in 2010 ended in live discharges. MedPAC states that an unusually high rate of live discharges for some providers raises concerns about questionable business practices.

On hospice in nursing homes, MedPAC notes the higher margins associated with some providers and continues to recommend medical review of hospice stays exceeding 180 days. To read the entire chapter on Medicare hospice policy issues, please click here.

In a chapter on post-acute care, MedPAC considers bundled payments of post-acute care (PAC) to be a means of changing the current fragmented fee-for-service system to one that encourages care coordination and cost control during an episode of care. The Commission believes that bundled payments would encourage accountability for care and quality across the spectrum of care. The chapter discusses design aspects of a sample 90 day episode starting with hospital stay and including PAC and physician services provided during the period. To read the full chapter on approaches to bundling payment for post-acute care, click here.

The MedPAC report also includes a chapter on care for dual-eligible beneficiaries, specifically highlighting a series of structured interviews performed by MedPAC staff with multiple stakeholders including providers, beneficiary advocates and health plans. The interviews covered five states with Medicare-Medicaid coordination programs including Florida, Massachusetts, Minnesota, North Carolina and Wisconsin.

To read the full MedPAC June Report to Congress, please click here.
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