‘Rip­ple ef­fect’

Medi­care re­im­burse­ment cuts would be un­fair, harm­ful: SNF reps

Modern Healthcare - - The Week in Healthcare - Paul Barr

Rep­re­sen­ta­tives for skilled-nurs­ing fa­cil­i­ties say the in­dus­try couldn’t han­dle the kind of Medi­care re­im­burse­ment cuts pro­posed in a re­port is­sued by HHS’ in­spec­tor gen­eral’s of­fice.

The in­spec­tor gen­eral’s 14-page re­port made pub­lic July 11 urges the CMS’ ad­min- a CMS news re­lease.

Of­fi­cials for Lead­ingAge, an as­so­ci­a­tion that rep­re­sents not-for-profit nurs­ing homes, ar­gue that an in­dus­try­wide cut of 11.3% would be un­fair, given some skilled­nurs­ing fa­cil­i­ties did not par­tic­i­pate in the kind of billing changes that pro­duced the ex­tra re­im­burse­ment. the agency would pro­vide a re­im­burse­ment in­crease of 1.5 per­cent­age points, or about $530 mil­lion, which the agency cal­cu­lated by ap­ply­ing the 2012 mar­ket­bas­ket in­dex of 2.7 per­cent­age points and re­duc­ing it by 1.2 per­cent­age points “to ac­count for greater op­er­a­tional ef­fi­cien­cies,” as out­lined in the Pa­tient Pro­tec­tion and Affordable Care Act.

In the sec­ond op­tion, the CMS would ad­just for the agency’s un­ex­pected spike in nurs­ing-home pay­ments dur­ing fis­cal 2011 with the 11.3% cut, which would re­quire re­duc­ing pay­ments to skilled-nurs­ing fa­cil­i­ties in fis­cal 2012 by $3.94 bil­lion.

The CMS’ changes that led to the shift in billing were in­tended to make re­im­burse­ment more re­flec­tive of the cost of care. Ex­pect­ing pay­ments to re­main level, in­stead the CMS saw re­im­burse­ment climb 16% to $14.8 bil­lion in the first six months of fis­cal 2011 from $12.7 bil­lion in the last six months of fis­cal 2010.

Most of the $2.1 bil­lion in­crease— $1.8 bil­lion—came from changes to ther­apy pay­ments within Re­source Uti­liza­tion Groups, which Medi­care uses to pay skilled­nurs­ing fa­cil­i­ties for ther­apy.

Providers shifted billing into higher-pay­ing RUGs and out of lower-pay­ing RUGs as a re­sult of the new billing choices, ac­cord­ing to the re­port. The choices gave nurs­ing homes a fi­nan­cial in­cen­tive to choose group ther­apy, which is sim­i­lar ther­apy of­fered to two to four pa­tients, over two other types, con­cur­rent ther­apy, which is when two pa­tients with dif­fer­ing care needs get ther­apy at the same time, and in­di­vid­ual ther­apy. The CMS has a fix for that and should im­ple­ment it right away, Phillips said.

The in­spec­tor gen­eral’s re­port also found some prob­lems re­gard­ing the time frame for when a skilled-nurs­ing fa­cil­ity can cal­cu­late which RUG a pa­tient be­longs in and rec­om­mends that skilled-nurs­ing fa­cil­i­ties re­cal­cu­late a ben­e­fi­ciary’s RUG when­ever his or her level of ther­apy changes sub­stan­tially.

The re­port notes that the in­spec­tor gen­eral in­tends to con­duct a full skilled-nurs­ing fa­cil­ity billing re­view at the end of the cur­rent fis­cal year, which con­cludes Sept. 30. “How­ever, based on the data in this re­port, CMS should take im­me­di­ate ac­tion,” us­ing its pend­ing skilled-nurs­ing fa­cil­ity fi­nal rule to do so, ac­cord­ing to the re­port.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.