We commend Senators Baucus and Grassley for pursuing a thoughtful, deliberative, inclusive approach to the sweeping health care policy reforms that will impact every American senior for decades to come. The Senate Finance Committee’s new “Policy Options” document proposes a variety of important initiatives that better orient our nation’s health care system toward more effective care coordination and better alignment of payment incentives and quality outcomes. The infrastructure investments necessary to achieve these goals are provided, and this is a laudable achievement.
Many of the options concerning post-acute care like those related to value-based purchasing and innovative chronic care management, and transitional care activities, for example, would complement and sustain ongoing government and profession-wide quality improvement efforts now making a positive difference in the lives of seniors. However, we are concerned that while “post-acute bundling” certainly deserves serious consideration, it nonetheless represents a substantial policy change that has yet to be adequately tested.
Absent further development, we believe a commitment to system-wide implementation could lead to unintended and unwelcome consequences for elderly beneficiaries, front line care staff, and the entire post-acute and long-term care sector. We believe a more cautious approach to post-acute reform that evaluates options in addition to bundling – like site-neutral post-acute payments – may be a better approach to rationalizing the coordination of acute and post-acute services, and the coordination of care across these settings.
We also are encouraged the new policy document includes nursing home transparency provisions that, overall, offer a sound approach to assuring providers report more meaningful information to the government, and that useful information is made available publicly. We support greater transparency and accountability, but several provisions in the options document may merit modification upon further review.
Moving forward, we urge the Committee to consider the need to address not only rationalization of the post-acute system but also reform of the long-term care delivery system. Now is the time to recognize and act upon the fact that patients, especially older Americans, have both chronic and intermittent health care needs. The options paper begins to address chronic care needs and care coordination, but remains incomplete until it also encompasses reform of the long term care system.
We look forward to working with Senators Baucus and Grassley, the other members of the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee to refine these options into a comprehensive health care reform proposal that earns the strong support of Congress, President Obama, and the American people.
The American Health Care Association and National Center for Assisted Living (NCAL) represent nearly 11,000 non-profit and proprietary facilities dedicated to continuous improvement in the delivery of professional and compassionate care provided daily by millions of caring employees to 1.5 million of our nation's frail, elderly and disabled citizens who live in nursing facilities, assisted living residences, subacute centers and homes for persons with mental retardation and developmental disabilities. For more information, please visit www.ahca.org or www.ncal.org.