Act aims to coordinate post-acute care to realize savings

Rep. David McKinley (R-WV), Rep. Jerry McNerney (D-CA) and Rep. Tom Price (R-GA) have introduced the Bundling and Coordinating Post-Acute Care (BACPAC) Act in an effort to coordinate care delivery and realize savings related to caring for the Medicare beneficiaries. 

The act, also known as H.R. 1458, would establish a condition-related group (CRG) payment system for post-acute care (PAC). Similar to the diagnosis related groups used by hospitals, CRGs would involve clinical condition-specific, site-neutral, bundled payments.

“BACPAC offers Congress a powerful opportunity to achieve significant savings through positive structural change rather than through higher beneficiary cost-sharing or further provider cuts,” Eric Berger, CEO of the Partnership for Quality Home Healthcare, said in a statement. “The BACPAC Act puts patient-centric solutions on the table that reward the delivery of coordinated, effective and efficient healthcare and benefit seniors, the Medicare program and taxpayers.”

Under the BACPAC model, coordinators would establish networks of PAC providers to deliver care at skilled nursing facilities, inpatient rehabilitation centers and long-term care hospitals as well as via home healthcare agencies. The coordinators and their networks of PAC providers would manage a person’s care for up to 90 days, using CRG payments that would begin on the day of the person’s discharge from the hospital. PAC coordinators would be held accountable for the cost of hospital readmissions, but participants would be rewarded if the total cost of a patient’s care is lower than the patient’s CRG bundled payment amount.

“It is an innovative approach to enhanced care coordination that aligns with our principles of care and focuses on the specific needs of the individual in the setting most appropriate, and not being limited by either the three-day stay or home-bound status,” LeadingAge said when the act, then known as H.R. 4673, was introduced in the House in 2014. The organization expressed concerns, however, saying that the proposal lacked patient-centered choices, that language was unclear about how providers would be selected and that funds also should be distributed to non-Medicare providers of home- and community-based services. LeadingAge also questioned whether a provision existed that would enable beneficiaries to opt out if they wished to do so.

Greg Crist, senior vice president of public affairs for the American Health Care Association (AHCA), told Inside CMS that AHCA supports the development of a PAC-only bundled episode and the elimination of the three-day qualifying inpatient stay, but the association does not agree with the bill in its entirety.

The congressmen forecast that the BACPAC Act would reduce overall Medicare spending for PAC services by four percent over the next 10 years—without reducing any provider’s rates—and would distribute all of the savings achieved beyond that level to the coordinator, discharging hospital, managing physician and PAC providers who serve each patient.

Berger said that his group will work with the legislators to advocate for their proposal.

Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.