At last week’s MedPAC meeting, staff and commissioners discussed the continued development of a unified post-acute care payment model as required by the IMPACT Act. Under a unified payment model, there would be a single payment model for the different post-acute care providers, including skilled nursing facilities, inpatient rehab facilities, long term care hospitals, and home health agencies. Payments under the model would vary based on patient characteristics, not the setting or amount of care provided. In September, MedPAC provided the overall proposed approach for a unified payment model. In last week’s meeting, staff primarily reviewed issues that were raised during the September meeting. The majority of the discussion focused on addressing companion policies that would be needed to minimize fee-for-service incentives that would remain if this payment model were implemented. Commissioners discussed how to develop incentives to prevent providers from minimizing care during a stay and discharging patients quickly to the next setting, among other concerns. There was significant discussion around whether a third party/risk-bearing entity would help meet the goals of increased quality and efficiency. Several commissioners argued against adding an additional administrative layer when it is unclear whether such an entity would provide value. Others suggested that whether a third party or a provider, the acceptance of risk would encourage more appropriate use of post-acute care services.
MedPAC Continues Development of Unified Post-Acute Care Payment Model