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AHA shares LTCH, IRF payment concerns with MedPAC

December 12, 2013

AHA yesterday reiterated its call for the Medicare Payment Advisory Commission to “re-evaluate its current path toward” eliminating the long-term care hospital prospective payment system and reimbursing LTCHs through the inpatient PPS. MedPAC, Congress’ top Medicare payment policy adviser, is weighing proposals to pay for all LTCH cases using IPPS rates and to modify the IPPS to better align payments and costs. MedPAC’s criterion for determining who are the sickest LTCH patients is too narrow and should be expanded to include “other clinical metrics to identify a set of high-acuity patients for whom LTCH-level care and payments are appropriate and warranted,” wrote Linda Fishman, AHA’s senior vice president for public policy analysis and development. The association also took aim at MedPAC’s consideration of equalizing payments rates for certain conditions in an inpatient rehabilitation facility to those of a skilled nursing facility. “IRFs are required to admit only patients who require hospital-level services, and payments should reflect the cost of providing that level of care,” Fishman noted. “SNF rates are wholly inadequate for IRF-level care.”