House subcommittee hears about bundled payments from post-acute care groups

The Subcommittee on Health of the U.S. House of Representatives’ Energy and Commerce Committee heard from several organizations yesterday as it held a hearing to examine the current state of post-acute care (PAC) in an effort to determine opportunities to improve service delivery and access.

“We believe PAC reform efforts in today’s healthcare environment are much more likely to succeed if they recognize the nature of skilled nursing facility patient and resident characteristics and service delivery which differentiate us from other PAC providers,” Leonard Russ, American Health Care Association (AHCA) board chair, told the committee.

The group encouraged lawmakers to work closely with the skilled nursing profession in the design of new person-centered, cost-effective payment systems. Russ testified to the skilled nursing profession’s commitment to quality, highlighting AHCA’s Quality Initiative. Since 2012, AHCA members have reduced hospital readmissions by 14.2 percent and off-label use of antipsychotic medications by 21.1 percent, he said. The Centers for Medicare & Medicaid Services’ five-star rating system for nursing homes has helped AHCA members become more cognizant of quality efforts, Russ added. He also discussed concerns with the proposed Bundling and Coordinating Post-Acute Care (BACPAC) Act of 2015, also known as H.R. 1458, which would implement a national, mandatory bundled payment system for all PAC providers beginning in 2017. AHCA believes the legislation lacks clarity and that other paths to advance PAC reform should be explored, Russ said, including AHCA’s Payment Reform Initiative, which is under development.

Steven Landers, MD, MPH, testified on behalf of the Partnership for Quality Home Healthcare (PQHH), saying the group supports the BACPAC Act because it encourages increased care coordination, patient choice and reduced healthcare spending. “We believe patient-centered care coordination can be achieved via PAC bundling that provides consistent support and navigation assistance to discharged Medicare beneficiaries” Landers testified (PDF).

The House subcommittee also heard from the Committee to Preserve Rehabilitation (CPR), a coalition with a steering committee that includes the Center for Medicare Advocacy, the National Multiple Sclerosis Society, the Brain Injury Association of America, United Spinal Association and the Christopher and Dana Reeve Foundation. In written testimony (PDF), CPR called PAC reforms proposed under the BACPAC Act “short-sighted, underdeveloped and untested” because they don't consider long-term cost-effectiveness, maximal patient outcomes and the future capacity of the rehabilitation system to continue serving Medicare beneficiaries with the most challenging conditions. Before payment bundling proceeds, CPR said, significant improvements and safeguards should be added to the BACPAC Act after significant data from the Improving Medicare Post-Acute Care Transformation (IMPACT) Act are analyzed. “Such post-acute care reform should incentivize good outcomes for patients, not just cost savings,” the group concluded.

The American Medical Rehabilitation Providers Association (AMRPA) also testified (PDF) that although it does not support the BACPAC Act in its current form, it welcomes the opportunity to work with members of the subcommittee to vet other proposals that would establish bundled payments for inpatient rehabilitation hospitals and units. “We remain concerned that prematurely implementing a bundled payment system presents risks to Medicare beneficiaries that outweigh the potential for Medicare program savings,” AMRPA said in written testimony. “Bundled payments must not act as a façade for reducing costs and shifting spending to other parts of the Medicare program at the expense of patients’ full recoveries from serious illness and injuries.”

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Lois Bowers

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