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MedPAC reviews possible new post-acute pay model

September 11, 2015
by Nicole Stempak, Associate Editor
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The Medicare Payment Advisory Commission (MedPAC) convened to review a prototype design that might meet guidelines for Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act).

The meetings, lasting yesterday and today, focused on creating a new unified payment system for post-acute care services that reflects the range of services provided with the Centers for Medicare & Medicaid Services new reimbursement model.

The proposed approach calls for two models based on service provider. Patients in skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals would be covered for non-therapy ancillary services, including ventilator services and drugs. There would be a separate component for home health agency patients, who are not currently reimbursed for those services. Commission staff said the model distinction was driven by a difference in cost, according to a news release from the American Health Association.

The commission’s report on the prototype is due to Congress June 2016.

The commission’s agenda also included sessions about factors affecting variation in Medicare Advantage plan star ratings.



Because proving you have a patient's clearly specified OK and justification to use ancillary life support services, machine driven care or specialized drugs, perhaps the most expensive part of long term medical or post stay care, is part of how medicare will decide on reimbursements, knowing that upfront becomes important.

What if the MD and the care-giving institution or service had the ability to do actually not prescribe some of the expensive and often cost rejected/non-covered aftercare and do so in good conscience?

Called "predictable care" its care based clearly on the patient's specific wants not prescribe nor use the more intense and machine driven care at all. It's based on the patient having decided and clearly specified that they want a specific quality of life as a result of the care approach and not pulling out all the stops as the care path they want.

In situations such as end of life or what to the patient would mean too much of trade off v quality of life a the patient defines it, That would surely result in a lot less expensive after care or end of life care costs yet not compromise the "quality" of care nor run afoul of Medicare's new "patient results" reimbursement rules that are now replacing process billing as the reimbursement approach.

If life support or radical measures such as those discussed in this article were clearly stated by the patient as "not wanted" in a self-declared checklist document and the MD has that patient written guideline (can be overwritten by the MD-its a guideline) on what they wanted, the "pull out all, the stops" care and its cost would not be delivered and the associated costs not incurred at all.

Since it was clearly written and stated by the patient, the fear of being sued for not pulling out all the stops could be a non-issue or easily disproven since the MD was clearly following the patients clearly stated wants.

This is all now very possible/doable with patient defined guidelines such as ThisIsWhatIWant, http;//, a much more specific checklist document for doing that with and for or by a patient than the many free state issued ones yet, being a guideline, its not legally binding onthe MD's judgement calls.

Its "predictive care = meeting patient's wants and concurrently managing/cutting care costs" is something an MD, CFO or the caring institution may want to do with every patient and every patient admission because it can deliver the "right" care as defined by each patient without compromising care quality and insurers along with CFO's will love the cost cutting v needed higher profits it delivers.

Perhaps such a tool could go a long way to helping meet medicare's new rules or any insurer's new rules for how or even if it decides to pay a claim

Neil Licht,