Post-Acute Care Bundling Payment Bill Introduced in the House
May 29, 2014 10:04 AM
Representative David McKinley (R-WV) recently introduced H.R. 4673, the Bundling and Coordinating Post-Acute Care Act of 2014 (BACPAC) on behalf of himself and Rep. Price (R-GA). According to the legislation, the purpose of the bill is to:
Foster the delivery of high-quality post-acute care services in the most cost-effective manner possible;
Preserve the ability of patients, with the guidance of their physicians, to select their preferred providers of post-acute care services;
Promote competition among post-acute care providers on the basis of quality, cost, accountability, and customer service;
Achieve long-term sustainability by ensuring operational stability through regional breadth and the engagement of experienced care PAC coordinators;
Advance innovation in fields including telehealth, care coordination, medication management, and hospitalization avoidance; and
Provide for the financial security of the Medicare program by achieving substantial program savings through maximized efficiencies, cost avoidance, and outcomes improvement.
NAHC is still analyzing all of the bill’s provisions to assess its potential affect on the home care community. NAHC is, however, encouraged that the bill would waive the homebound requirement for home health services.
Rep. McKinley is a strong proponent of home health care. He and Rep. Doris Matsui (D-CA) initiated a bipartisan Congressional sign-on letter to CMS seeking relief from the Medicare home health payment rebasing rule.
McKinley introduced H.R. 4673 following last week’s Energy and Commerce Health Subcommittee hearing on Medicare payment reforms. For more coverage from NAHC Report on that hearing, please click here.
During his introductory remarks at the hearing, Rep. McKinley stated that:
“This bill develops a model for post-acute care services that will increase efficiency, encourage more choice and personalize care for patients and offer significant savings to the program in the process...This bill could save as much as $85 - $100 billion…We are encouraging efficiency in services and programs that are more patient-centered.”
NAHC offered its vision for post-acute care payments in the Statement for the Record that it submitted for the Energy and Commerce Health Subcommittee hearing where this legislation was reviewed, stating that:
“It is important that bundling arrangements for PAC allow PAC providers to hold and administer the risk-adjusted PAC benefit, not the acute care provider. The expertise related to managing patients in a post-acute setting lies with PAC providers, not hospitals, and the payment and accountability should be structured to reflect that. We are encouraged that CMS is testing a post-acute care bundling program where all provider payments are managed by home health agencies. We believe this will ultimately deter unnecessary re-hospitalizations, thus reducing administrative burden and cost. This approach is comparable to the tried and tested Medicare hospice program where payment is bundled to a community-based hospice program where hospitalization is the exception rather than standard practice.
Given the evidence regarding the importance of involving home health providers early in the care transitions process, the most effective bundling model would integrate home health providers into the hospital discharge planning process upon the admission of a qualified patient to the hospital. The home health agency would be responsible for a comprehensive evaluation and PAC planning process that is designed to determine whether a patient is medically appropriate and feasible for discharge to the community.
Where the home health agency, in close coordination with the hospital, determines that community based care is not appropriate immediately upon hospital discharge, the responsibility for discharge to a post-acute inpatient setting is returned to the hospital. At that point, a post-acute inpatient care bundling may be triggered, if available.
With this model, the home health agency is responsible for any community-based care related to the patient’s inpatient treatment including home health services, physician services, outpatient rehabilitation services, and any intervening stay in an inpatient rehabilitation facility (IRF), long term care hospital (LTCH), or skilled nursing facility (SNF). Post-acute inpatient stays immediately following hospital discharge are outside of the home health agency responsibility.
Benchmarks could be based on existing measurements of quality and patient outcomes in combination with cost avoidance outcomes that relate to re-hospitalizations and use of emergent care.
Under a post-acute community based care bundling approach, providers would receive a case mix related per capita payment that is calculated on the basis of the combination of services in the bundle, adjusted for performance in a positive or negative manner.
One key aspect of making a bundled payment work is ensuring the technological means to share information among providers. Seamless care transitions depend on physicians, hospitals and home health agencies having access to patient information. The home care community has been an integral partner within the Standards and Interoperability (S&I) Community-Led Initiatives, such as the Longitudinal Coordination of Care (LCC) workgroup, to develop standards for interoperable transitions of care and care plans additions to the Consolidated Clinical Document Architecture (CCDA). Our goal is to leverage the support of these important editions to the CCDA to encourage the adoption of electronic health records (EHR) and also to support the interoperable exchange of health information that is the foundation for building new models of care delivery in home care.”
For more on H.R. 4673, please click here.
To read NAHC’s full statement on Medicare payment reforms, please click here.