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eHDS User Group: While CMS continues to innovate, unpredictable Congress could cut healthcare funding

June 21, 2012
by pamela tabar
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Healthcare issues on Capitol Hill, innovations in accountable care and emerging payment models dominated the closing keynote of the eHDS User Group meeting June 20 in Cleveland.

While everyone waits for the SCOTUS decision on the Affordable Care Act, Congress still has plenty of healthcare-related bills to sort through before the end of the year, noted keynote speaker Cynthia Morton, executive vice president for the National Association for the Support of Long Term Care (NASL) and the former vice president for political affairs at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

Congressional actions can be quirky during an election year, she said. Legislators may choose to postpone controversial bills until after the election, creating a lame-duck voting floor.

One of the important long-term care/post-acute care pieces still at-large is the Therapy Cap Exceptions Extension, enacted this spring. The extension affects any facility or organization that offers therapy services. Unless Congress renews it, the extension will run out on December 31. If Congress delays the topic until 2013, it could take a month before the new Congress is settled in enough to deal with the bill, she warned. “Meanwhile, you’ve gone for weeks being unable to get patients who might have hit that cap through the exceptions process.”

Morton also discussed many of the projects and initiatives that are building the foundations in onsite care delivery improvements and in the transition of care to other facilities. One of the busiest agencies this year has been the Centers for Medicare & Medicaid Services. “CMS has been going through a real transformation, and they’re pumping out policies about every four weeks,” she said. 

Current initiatives show CMS’ dramatic philosophy change concerning payment models. “The PPS system we’ve been using isn’t really working,” Morton said. “It doesn’t incentivize quality and cost savings, and tinkering with it isn’t going to provide the results they want.”

Future models will include payment systems for dual eligibles, Accountable Care Organizations (ACOs), managed care, bundled payors and medical homes.

Bundling may be the hottest topic of all, Morton noted. CMS is developed four models for bundling, two of which include post-acute care.

“Like an ACO, bundling rewards providers for taking accountability,” she explained. “The difference is that bundling supports accountability at the patient level, whereas the ACO model does it at the population level.” 

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