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Nursing home care, rehab hospital care not equal, group maintains

December 17, 2014
by Lois A. Bowers, Senior Editor
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The American Medical Rehabilitation Providers Association (AMRPA) is calling on members of the Medicare Payment Advisory Commission (MedPAC) to reject a proposal to pay the same amount for rehabilitation regardless of whether a Medicare beneficiary is treated in an inpatient rehabilitation hospital or nursing home. MedPAC may vote on the proposal this week.

In a letter (PDF) sent today to the commissioners, AMRPA echoes many of the concerns expressed recently by the Coalition to Preserve Rehabilitation. The AMRPA letter argues that the currently crafted proposal would:  

  • Put Medicare beneficiaries in jeopardy if they are diverted into less-intensive rehabilitation settings despite clinical needs for more intensive treatment.
  • Prioritize cost considerations over patient outcomes. A comprehensive study, AMRPA says, shows that patients have better outcomes when treated in rehabilitation hospitals and units rather than in nursing homes.
  • Not acknowledge the significant clinical difference between rehabilitation hospitals and nursing homes. Rehabilitation hospitals and nursing homes may have some common features, but the care they provide is not the same and should not be treated as such, AMRPA says. Rehabilitation hospitals must meet stringent criteria to be licensed as a hospital, according to the organization, but “there are virtually no regulations that set quality standards and proper medical supervision for rehabilitation provided in nursing homes.”
  • Base decisions on the “site–neutral” theory, which is untested and not evidence-based. Until passage of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act this year, no requirements existed related to reporting comparable data on outcomes for those treated in rehabilitation hospitals and nursing homes. The IMPACT Act will provide a chance to analyze comparable data on patient outcomes, and reforms should wait until that time, AMRPA says.

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'Site-neutral' payment proposal pits rehab hospitals against nursing homes