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MedPAC recommends site-neutral payments for rehab

January 16, 2015
by Lois A. Bowers, Senior Editor
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The Medicare Payment Advisory Commission (MedPAC) has unanimously voted to recommend “site-neutral” payment for certain Medicare beneficiaries who need medical rehabilitation following injury or illness. The Coalition to Preserve Rehabilitation (CPR) and the American Medical Rehabilitation Providers Association (AMRPA) expressed disappointment in the decision. Congress will decide whether to adopt MedPAC’s recommendation.
MedPAC’s action was spurred by the IMPACT Act, which directs the Centers for Medicare & Medicaid Services (CMS) to develop a uniform data set across all settings of post-acute care. CPR, which represents consumer, disability and clinician organizations, believes that MedPAC's recommendation would result in the inappropriate diversion of patients who need inpatient hospital rehabilitation to less-intensive settings, such as nursing homes, based on diagnosis alone, not based on the individual medical and rehabilitation needs of patients.
“Site-neutral payments are a penny-wise, pound-foolish approach, prioritizing short-term cost considerations over long-term patient outcomes,” Maggie Goldberg, vice president of policy and programs at the Christopher & Dana Reeve Foundation and a CPR member, said in a statement. “MedPAC fails to consider the long-term patient impact of diverting beneficiaries into less-intensive rehabilitation settings despite their clinical needs.”
AMRPA Chairman Bruce M. Gans, MD, who also serves as chief medical officer for the Kessler Institute for Rehabilitation, in a statement, said: “MedPAC’s site-neutral recommendation is based on a mistaken belief or assumption that rehabilitation hospitals and nursing homes produce comparable outcomes. Seemingly ignored is research that shows patients have better survival rates and outcomes when treated in rehabilitation hospitals rather than nursing homes. In fact, not only do patients live longer, they go home sooner and have fewer hospital readmissions.”

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