Medicare Compliance & Reimbursement

CMS wants to standardize clinical data collection across different service sites.

Providers' post-acute care services reimbursement could soon reflect patients' entire post-acute care episode, instead of the type of care setting.

The Centers for Medicare and Medicaid Services, the Medicare Payment Advisory Commission and other stakeholders should focus on developing a payment system that addresses the "overall post-acute episode, rather than each individual component of the continuum of care," according to Center for Medicare Management director Herb Kuhn's June 16 testimony before the House Committee on Ways and Means.

The proposed payment changes would affect skilled nursing facilities, home health agencies, long-term care hospitals and inpatient rehabilitation facilities. Using common clinical measures and processes to assess patients is the "key to developing more consistent payment and quality assurance methodologies across different sites of post-acute care," Kuhn says.
 
Interoperable data standards could allow providers to share patient information across different post-acute care settings and may reduce avoidable re-hospitalizations and other care quality problems during transfers between facility types, he notes.

Downside: CMS also wants to add diagnosis-related groups to existing acute care hospital payment policies and pay hospitals on a per-diem basis for shorter than average stays when transferring to a post-acute care setting, rather than the full DRG payment, Kuhn says.