Home Health & Hospice Week

Commission accuses HHAs of gaming assessments for financial, quality gains.

The impact may not be as immediate as the Medicare Payment Advisory Commission’s 5 percent cut to Medicare home health payments it recommended earlier this year, but Post Acute Care Prospective Payment System suggestions in its latest report to Congress could still shape your future.

The report released June 14 addresses an issue that MedPAC has been advocating for a while — a unified payment system across the post-acute care (PAC) payment settings of home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals.

“Despite some actions by the [Department of Health and Human Services] and the Congress, Medicare’s payments remain too high relative to the costs of treating beneficiaries in three of the four settings (SNF, HHA, and IRF),” MedPAC judges. “In June 2016, the Commission evaluated a prototype design and concluded that a unified PAC PPS would establish accurate payments and increase the equity of payments across conditions.”

MedPAC raises some questions about setting such a unified PAC PPS, however, including:

• Whether the Centers for Medicare & Medicaid Services should rely on patient assessment data reported by providers. MedPAC cites instances where functional assessments don’t match up for the same patient at different PAC providers. “Differences revealed how achieving certain scores would raise providers’ payments and would show larger than warranted improvement in quality performance,” the report says. “The large differences and apparent bias in the reporting suggest these data must be improved to reliably capture meaningful differences among patients.”
• Whether payment should be based on an episode or a “stay.” MedPAC “favors pursuing a stay-based design as the initial strategy to better protect beneficiaries against undesirable provider behavior,” the report says.
• How to standardize regulatory requirements across settings.

Note: See the 66-page chapter on the unified PAC PPS at www.medpac.gov/docs/default-source/reports/jun19_ch9_medpac_reporttocongress_sec.pdf.