Home Health & Hospice Week

Will hospitals control HHA payments some day?

The results aren't yet in from demonstration projects that Medicare is running on bundling of post-acute services, but that isn't stopping the Medi-care Payment Advisory Commission from forming opinions on the payment methodology.

Background: Numerous law- and policy-makers including President Obama have promoted the idea of bundling Medicare payments for post-acute care providers in hopes of gaining efficiencies and coordinating care between settings. And last year, the Centers for Medicare & Medicaid Ser-vices put out a request for application (RFA) for the first phase of its Bundled Payments for Care Improvement demonstration project, as required by the Affordable Care Act (see Eli's HCW, Vol. XX, No. 31, p. 244). Under that initiative, CMS will test varying payment bundling methodologies that would group post-acute care provider payments together with hospital payments, and keep post-acute providers' pay bundled only with other post-acute care providers.

In its Sept. 6 meeting, MedPAC examined the issue of bundling post-acute care services. Bundling has many variables to consider, such as whether to group payments with hospitals', length of the bundling period, and whether to factor in hospital readmissions.

MedPAC stopped short of making recommendations, but continues to "explore" the concept of bundling, noted MedPAC staffer Evan Christ-man in the meeting.

That's despite CMS's finding in a report earlier this year that bundling between home care and other post-acute providers is an ill fit. "Evidence supports the potential for development of a common payment system for the three inpatient [post acute care] settings: LTCHs, IRFs, and SNFs," said the CMS report on the Post Acute Care Payment Re-form Demonstration. "Evidence supports modeling home health routine service use separately from the other PAC settings."

Why? "The pattern of resource intensity in the home health setting is significantly different than seen in the three inpatient PAC settings," CMS noted in the report. "This may be due in part to the different nature of providing care and staffing in a home based setting compared to an inpatient setting" (see Eli's HCW, Vol. XXI, No. 6).

Home care providers have long expressed dismay over the idea of having both reimbursement and referrals controlled by hospitals under bundling.

To see slides from the presentation and a transcript of the meeting, go to www.medpac.gov/meetings.cfm and select the Sept. 6-7 meeting link.