NEUTRAL PAYMENT: GOOD QUICK FIX OR A KLUDGE? MEDSTAR NRH RESEARCHER LOOKS AT PROS/CONS

At the June National Health Policy Forum on Capitol Hill, MedStar NRH’s Gerben DeJong, PhD, FACRM, joined other health care and government leaders to take a look at another proposed reform—not authorized by the ACA—that is producing heated debate, namely, “site-neutral payment” for post-acute care.

September 2, 2015

 

 

WASHINGTON, DC – Sept. 2, 2015 – With yet another affirmation by the U.S. Supreme Court, most pundits agree that the Affordable Care Act (ACA) is here to stay.  But many policy issues remain as the health reform continues to be implemented.

Gerben DeJongAt the June National Health Policy Forum on Capitol Hill, MedStar NRH’s Gerben DeJong, PhD, FACRM, joined other health care and government leaders to take a look at another proposed reform—not authorized by the ACA—that is producing heated debate, namely, “site-neutral payment” for post-acute care.

Under site-neutral payment, services provided to patients with similar conditions and characteristics would be reimbursed the same amount no matter where the service is rendered.  The idea has most frequently been discussed for payment of post-acute care. Under proposed policy, services provided by skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) would receive the same reimbursement.

In its March report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended a phased-in elimination of differences in payment rates between IRFs and SNFs for selected conditions, otherwise known as site-neutral payment.

Dr. DeJong, senior fellow for health policy and post-acute care at MedStar NRH, was among the forum’s panelists.  He expressed his concerns about site neutral payment—characterizing it as a “kludge”—a temporary, clumsy solution to a complex issue.

“Site neutral payment is seen by some as a step toward the inevitable—bundled payment or fixed payment for an episode of acute and post-acute care,” Dr. DeJong says. “I think we should stop tweaking the old system. When you add enough kludges the result is a complex system that is difficult to understand—and hard to use,” he adds.

“We have over 400 Medicare bundled payment demonstrations and over Medicare 400 ACOs [Accountable Care Organization] underway right now—as a result of the Affordable Care Act,” Dr. DeJong adds.  “Let’s first learn from them to determine what works and doesn’t, and how these demos are reinventing acute and post-acute care. This is where we need to put our analytic energy.”

“Bundled or episodic payment is the ultimate site-neutral payment system and is where post-acute care is destined to go.  We need to learn how to make it work so that it optimizes patient outcomes using a level playing field without creating unintended effects that so often accompany payment reform,” Dr. DeJong says.

The debate over site-neutral payment is likely to continue for months—with various opinions voiced from many quarters. “But with bundled payment for a given episode of care as our destiny, I strongly believe discussion of this stop-gap measure is an unnecessary distraction.”

 


 

About MedStar National Rehabilitation Network

The MedStar National Rehabilitation Network (MedStar NRH) is a regional system of rehabilitation care that offers inpatient, day treatment and outpatient services in Washington, D.C., Maryland and Northern Virginia.

The Network’s interdisciplinary team of rehabilitation experts provides comprehensive services to help people recover as fully as possible following illness and injury.  Rehabilitation medicine specialists, psychologists, physical and occupational therapists, and speech-language pathologists work hand-in-hand with other rehab professionals to design treatment plans tailored to each patient’s unique needs.  Rehabilitation plans feature a team approach and include the use of state-of-the-art technology and advanced medical treatment based on the latest rehabilitation research.  

The Network provides comprehensive programs specifically designed to aid in the rehabilitation of adults and children recovering from neurologic and orthopedic conditions such as amputation, arthritis, back and neck pain, brain injury, cancer, cardiac conditions, concussion, fibromyalgia, foot and ankle disorders, hand and upper extremity problems, post-polio syndrome, stroke, spinal cord injury and disease, and sports and work-related injuries.

Inpatient and day treatment programs are provided at MedStar National Rehabilitation Hospital located in Northwest Washington, DC and at more than 40 outpatient sites conveniently located throughout the region.  MedStar NRH is consistently ranked by physicians in U.S. News & World Report as one of America’s “Best Hospitals” for Rehabilitation, and is fully accredited by The Joint Commission,  the Commission on Accreditation of Rehabilitation Facilities (CARF), with CARF accredited specialty programs for Amputations, Brain Injury, Spinal Cord Injury and Stroke.

For more on MedStar NRH and to find a location near you, log on to MedStarNRH.org.

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