Ways & Means Health Subcommittee Explores Value Based Purchasing in Post-Acute Care Settings, Updates Legislation
September 8, 2016 04:24 PM
This week the Ways and Means Health Subcommittee held a hearing on the evolution of quality in Medicare Part A to examine whether existing policies are improving quality and cost-efficiency of care in hospitals and what opportunities there are to improve care delivery in post-acute care settings. As Ways and Means Committee Chairman Kevin Brady stated, “Physician payment policies are just one piece of the puzzle. To ensure the Medicare program is truly delivering the high-quality care seniors deserve, we also need to improve the way it pays post-acute, or after hospitalization providers.”
This hearing was held immediately following the release of draft changes to the Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298). (A summary of the original bill can be found here.) The legislation would create an incentive pool for four post-acute settings – home health agencies, skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals. When the legislation was first introduced in 2015, NAHC and other post-acute care organizations expressed concerns with the program. Concerns included that the program does not adhere to the implementation timeline that was established under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, quality measures (rather than just a focus on spend) should be narrow and include at least one measure focused on patient outcomes, and the withhold amount in a program should not be more than two percent at full implementation.
Some of the modifications included in the draft changes include adding the functional status measure from the IMPACT Act to take effect in 2020. The amount at risk is five percent, compared to the 3-8% phase in included in the original bill. The savings in the bill are funneled to the Medicare Improvement Fund and earmark them to be used for “regulatory relief.” However, it is expected that this provision will change and the savings will be attributed to a more prescriptive set of provisions providing regulatory relief. NAHC remains in close contact with the committee regarding the regulatory relief needed within the home health sector.
NAHC will have the opportunity to provide feedback in the coming weeks on the changes made to the legislation. The changes to the original bill are fairly minor and overall NAHC’s concerns do not appear to be adequately addressed. The timeline in the updated legislation does not align well with the IMPACT Act, is before validation of quality measures, and is at a level of risk higher than NAHC deems appropriate given that post-acute care providers are subject to various Medicare payment cuts. NAHC joined other stakeholders in a meeting with Chairman Brady where these general concerns were expressed.
NAHC will be reviewing the changes to the legislation and will continue to express concerns and provide suggestions to the Ways & Means Committee. NAHC’s position on the details will include the following principles:
The IMPACT Act should be fully implemented before any payment reforms are imposed based on the value/quality measures in the Act.
Value based purchasing measures should be focused on a broad set of patient outcomes.
Any measures used in value based purchasing should be fully tested for validity and reliability.
The amount that value based purchasing puts at risk should be only the level that is sufficient to change provider behavior to focus on quality outcomes. Putting too much at risk could trigger the closure of providers that lack sufficient resources to improve performance.
A post-acute c are value based purchasing program should be implemented as budget neutral.