Further Concerns Raised about Bundling Legislation
Congressman McKinley Speaks in Support; Center for Medicare Advocacy Expresses Concerns
May 21, 2015 10:50 AM
Over the past two weeks, there has been continued discussion among lawmakers and stakeholders who are divided over legislation—the Bundling and Coordinating Post-Acute Care (BACPAC) Act (H.R. 1458)—that would bundle Medicare payments for post-acute care. As previously reported, the House Energy & Commerce Subcommittee on Health held a hearing last month to discuss the bill and how best to improve post-acute care. NAHC submitted an official statement for the hearing record that outlined principles for improving post-acute care and expressed concerns with certain aspects of BACPAC.
Most recently, the bill’s sponsor, Congressman David McKinley (R-WV), delivered comments yesterday at a briefing hosted by the Alliance for Home Health Quality and Innovation promoting the legislation. You can access more information about the briefing here.
McKinley has argued that his legislation will strengthen Medicare by improving care coordination, and during his remarks yesterday he said the bill would help make “commonsense savings to preserve Medicare services, protect jobs, and make sure we keep our promise to seniors.”
However, McKinley’s comments in support of the legislation followed the release last week by the Center for Medicare Advocacy of an article expressing concerns with the bill, including that it might cause “skimping” in post-acute care for patients and that it focuses more on cutting costs than on improving care coordination.
“Unfortunately, BACPAC adds a financial incentive to skimp on post-acute care,” wrote CMA. “The bill’s requirement to phase in bundled payments, beginning with the highest cost beneficiaries, also suggests that cost-savings, rather than improved coordination of care for patients, is the key goal of the legislation.”
CMA also said the bill raises concerns about “patients’ rights, conflict of interest, unrecognized Medicaid costs, and observation status.” With regards to patients’ rights, CMA stated that the bill fails to address whether patients would be able to select a care coordinator and what information would be available to them about the network and providers available in doing so. CMA also questioned the lack of rights for patients regarding notice and appeal.
CMA further noted conflict of interest with the coordinator having a financial incentive to select low cost, rather than high quality, care for patients. In addition, the CMA article further described the bill’s exclusive focus on Medicare without including Medicaid and that it contains a loophole for patients who return to a hospital as an outpatient including observation status.
The concerns CMA were similar to those expressed by NAHC and members of Congress as part of the House hearing on post-acute care last month. In its official statement for the hearing record, NAHC stated it would be premature to move forward with the legislation before Congress can learn from ongoing demonstration projects and expressed concerns with specific aspects of the legislation, including: the exclusion of Medicare physician services from bundling; too much deference to federal agencies on PAC bundling design; and failure to integrate with the IMPACT Act in developing uniform assessment tools to enable bundling in the PAC setting. During the hearing, multiple members of Congress expressed similar concerns.
To read NAHC Report’s previous article about the House hearing, please click here.