‘Site-neutral’ payment proposal pits rehab hospitals against nursing homes

People requiring intensive rehabilitation care are better served by inpatient rehabilitation hospitals than by nursing homes, according to the Coalition to Preserve Rehabilitation (CPR), so “site-neutral” payment proposals that would equalize payments between both settings, potentially resulting in the diversion of more patients to nursing homes, trouble the group.

CPR submitted a letter to the Medicare Payment Advisory Committee (MedPAC), which is set to recommend this policy approach to Congress later this month, and provided written testimony to the House Energy and Commerce Health Subcommittee, which held a hearing yesterday with the executive director of MedPAC. CPR maintains that site-neutral payments prioritize cost containment over clinical needs. In its letter and testimony, the group says that a decision on site-neutral payments should be delayed until more data are available to examine how patients would be affected.

“Site-neutral proposals are based on a false premise that inpatient rehabilitation hospitals and nursing homes provide the same level of rehabilitation care,” Susan H. Connors, president and CEO of the Brain Injury Association of America and a CPR member, said in a statement. “While I appreciate that MedPAC is trying to save money, it should not do so at the expense of vulnerable Medicare beneficiaries, who may be denied the intensive and coordinated hospital-level rehabilitation care they need.”

The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, passed in September and generally supported by the American Health Care Association/National Center for Assisted Living, LeadingAge and other groups, required MedPAC to provide Congress with new models for post-acute care payments, including bundled and site-neutral payments. The site-neutral payment approach, however, is untested, Susan Stout, president and CEO of the Amputee Coalition and a CPR member, said in a statement. Implementation of the IMPACT Act, she added, “will finally provide a chance to analyze comparable data on patient outcomes across different settings.” MedPAC's proposal, Stout said, “seems to ignore the most comprehensive study to date that shows patients treated in rehabilitation hospitals have better outcomes, go home earlier and live longer than similar patients treated in nursing homes, including some of those proposed for site-neutral payments.”

Although MedPAC is set to vote later this month on its site-neutral proposal, the commission has not publicly released a list of the 17 conditions affected by this policy, CPR says. “I’m very concerned about MedPAC’s lack of transparency in its rush to approve a site-neutral payment recommendation,” Judith A. Stein, executive director of the Center for Medicare Advocacy, said in a statement. “A decision that threatens so many Medicare beneficiaries should not be brokered behind closed doors. To make matters worse, MedPAC is not expected to seek public comment on this proposal at their December meeting until after the vote is scheduled to occur.”

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