Washington Update: Monday, February 20, 2023

POST-ACUTE

CMS seems in no hurry to try “unified” post-acute care, but risks remain.

For more than a decade, policymakers have flirted with merging (“unifying”) the four post-acute care systems – HHA, IRF, LTCH & SNF – into one new, untested system. In 2022, CMS released a long-awaited report and confirmed how difficult, if not impossible, such an undertaking would be. Patients should have access to high-acuity post-acute care. The current post-acute continuum, while not perfect, represents a rational progression of care and gives patients a range of options.

Some “MA” plans are unduly restricting patient access to post-acute care.

There are wide disparities in patient access to post-acute care hospitals for patients in the MA program as compared to the original Medicare fee-for-service (FFS) program. We believe all Medicare patients should have ready access to all Medicare covered benefits, including care in an IRF and LTCH when medically appropriate. The Biden Administration has recently announced several new regulatory policies which may change the way MA plans use “prior authorization.”

LTCHs

LTCHs played a key role during the pandemic and deserve reconsideration.

We are proud of the role LTCHs played in responding to the pandemic. But the number of LTCHs in the nation continues to decline as the 2013 criteria continues to tighten patient eligibility for LTCH care. We supported the 2013 criteria as a way of clarifying the role of LTCHs, but policymakers should reconsider whether the number of LTCHs has now declined too much. With tightening admissions in all post-acute venues of care (LTCH, IRF, SNF), there is a growing population of high-acuity patients who have no options when being discharged from hospitals.

IRFs

HHS should reconsider how it conducts a coming wave of IRF audits.

HHS-OIG has long said it plans to conduct more IRF audits, saying medical record documentation from some IRFs do not meet Medicare requirements to support IRF-level of care. We believe HHS has many other, more reasonable, more targeted, and less burdensome tools than “Review Choice Demonstration” to investigate potential fraud.  Select Medical urges HHS to develop a more tailored approach, focusing only on IRFs with questionable compliance practices.

OUTPATIENT

Tired of annual fixes, Congress may be ready for bigger Part B reforms.

Congress has acted every year for the past several years to mitigate CMS’ planned cuts in Part B rates. But, with Republicans now in control and with all lawmakers frustrated with past Part B reforms, Congress may pivot and try broader reforms. These efforts may take several years – since major Medicare changes are unlikely with a Republican House and a Democratic White House. We believe payment changes for PT providers must always be sufficient to offset rising costs.

MEDICARE

On the heels of a global pandemic, cutting Medicare makes no sense at all.

Medicare’s Part A Trust Fund will become insolvent sometime in the next 3-4 years. This happens just about every decade. And, when it does, policymakers generally use a mix of revenue raisers (tax/fee increases) and expense cuts (lower Medicare rates) to extend the life of the trust fund. Good examples include the Affordable Care Act of 2010 and the Balanced Budget Act of 1997. In the wake of a global pandemic, policymakers are thankfully not in a rush to cut Medicare.

Periodically “Sunsetting” Medicare would be a dangerous gamble.

Last Fall, Sen. Rick Scott (R-FL) put out a policy platform, calling for Medicare to be periodically renewed by Congress. This process is called “sunsetting” meaning that Medicare’s legal standing would end, and Congress would have to periodically re-authorize it. Scott’s concern is that Medicare spending is on autopilot and Congress should have more control. However, such a move could make Medicare an unreliable partner/payor for the nation’s hospitals and American seniors.

Raising Medicare’s eligibility age will do little to shore-up Medicare finances.

Another idea some Members of Congress are considering is to raise the age for Medicare eligibility from 65 to 70. This idea might make more sense in Social Security where it would generate savings but, in the Medicare context, the Congressional Budget Office has already said changing the Medicare age would not generate much savings for Medicare (simply because most seniors don’t use much Medicare services until later in life).

We seek the support of both parties to protect patient access to our care.

As a national healthcare company, we hope to earn the support of both political parties. We hope to have the support of Democrats since they have been long-time champions of Medicare, one of our biggest payers. We hope to have the support of Republicans since they have been long-time champions of private-sector solutions to providing healthcare.