In March 2014, MedPAC unveiled its case for site-neutral payments for several conditions that are treated in both skilled nursing facilities (SNFs) and in-patient rehabilitation facilities (IRFs). The MedPAC data and analyses are compelling and groundbreaking. The Commission examined three specific conditions: stroke, major joint replacement, and hip fractures. They concluded the following:
- For select conditions, characteristics of beneficiaries admitted to IRFs and SNFs in the same market were similar;
- In addition, the prevalence of comorbidities of beneficiaries were similar but patients treated in SNFs were more likely to have several of the comorbidities;
- Outcomes between IRFs and SNFs were basically the same for the identified conditions. There were no significant differences in risk-adjusted readmission rates between IRFs and SNFs; no significant differences in mobility, and, with respect to self-care, there were no significant differences for orthopedic conditions but some higher rates of improvement for IRF patients.
The Commission concluded that the work on orthopedic conditions was a strong starting point for a site-neutral policy. MedPAC staff will continue to explore site neutral payment between SNFs and IRFs.
Download MedPAC’s Findings >>
A few of the key milestones in the site neutral discussion include the following:
- The Deficit Reduction Act (DRA) of 2005 mandated a demonstration that supports site-neutral. This mandate resulted in the development of a common assessment tool which could facilitate significant movement toward the ability to compare patients across settings. This assessment tool could also help reshape current PAC payment systems to pay for similar services to similar patients, despite the settings.
- In the April 2013 Moment of Truth Project report, “A Bipartisan Path Forward to Securing America’s Future,” the co-chairs, Erskine Bowles and Senator Alan Simpson proposed reforming PAC payments and included a proposal to equalize payments between across PAC settings.
- The Fiscal Year 2014 “President’s Plan For Economic Growth And Deficit Reduction, Legislative Language and Analysis” proposed to restructure PAC payments. The legislative language proposed to adjust Medicare payments for three conditions involving hip and knee replacements and hip fracture as well as other conditions selected by the Secretary at her discretion. The Budget indicated these conditions are commonly treated at both IRFs and SNFs, but Medicare pays significantly more for patients treated in IRFs. The Budget clearly stated that IRFs provide intensive inpatient rehabilitation care that may not be needed for patients with certain conditions and whose care needs could reasonably be expected to be met in a SNF.
Download “The Case for Site Neutral” >>