McKnight’s reported that the Medicare Payment Advisory Commission (MedPAC) has unanimously voted to recommend site-neutral payments for certain post-acute services, which will eliminate differences in payments between inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) for selected orthopedic conditions. MedPAC recommended that the change be phased in over the next several years, through 2017, and said equalizing the payments would save Medicare about $1 billion per year.
MedPAC said it does not anticipate that patients would be negatively affected because analysts have not observed significant differences in outcomes between the two provider types, McKnight’s stated, adding that IRF stakeholders object to this finding.
“Seemingly ignored is research that shows patients have better survival rates and outcomes when treated in rehabilitation hospitals rather than nursing homes,” Bruce M. Gans, MD, chairman of the American Medical Rehabilitation Providers Association (AMRPA) was quoted as saying. “In fact, not only do patients live longer, they go home sooner and have fewer hospital readmissions.”
The research that Gans referred to was a study commissioned by AMRPA and conducted by Dobson DeVanzo & Associates, Vienna, Virginia. Among other things, the study, which the Amputee Coalition reported on last year, showed that patients with limb loss return home more quickly and live longer when treated in IRFs rather than in SNFs.
The Coalition to Preserve Rehabilitation, an alliance of consumer, disability, and clinician organizations, called MedPAC’s decision an “overreach,” the McKnight’s article stated. The commission failed to consider the effects of comorbidities and complications when it was reviewing 22 possible conditions for inclusion, and so failed to understand how amputees and other patients with complex needs could suffer from being “diverted” to SNFs rather than being admitted to IRFs, stated coalition member Sue Stout, executive director of the Amputee Coalition.
MedPAC now will formally recommend this policy to Congress.