A draft health reform bill released late last week by three House committee leaders includes significant measures to develop a bundled payment policy for post-acute care services under Medicare. The bill, drafted by House Education and Labor Committee Chair George Miller (D-California), House Energy and Commerce Committee Chair Henry Waxman (D-California) and House Ways and Means Committee Chair Charles Rangel (D-New York) would require the Secretary of Health and Human Services (the “Secretary”) to develop a detailed plan to reform payment for post-acute care services.
The stated goals of the plan to reform payment are to improve the coordination, quality, and efficiency of post-acute care services and to improve outcomes for individuals, including reducing hospital re-admissions. The bill would require the Secretary’s plan to include detailed specifications for a bundled payment for post-acute care services. Post-acute care services to be included in the post-acute care bundle are services for which payment may be made under Medicare for services furnished by skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long term care hospitals (LTACHs), hospital-based outpatient rehabilitation facilities, and home health agencies. In developing the plan, the Secretary would be required to consider several issues:
In addition to framing the issues for consideration by the Secretary, the bill would require the Secretary to expand the Acute Care Episode (ACE) Demonstration for Medicare to include post-acute care services no later than six months after enactment of the bill. The ACE Demonstration is being conducted to test the effect of bundling Part A and Part B payments for select cardiovascular and orthopedic episodes of care to improve the coordination, quality, and efficiency of that care. Five sites located in Texas, Oklahoma, New Mexico, and Colorado were selected to participate in the Demonstration.
It is too early in the health reform debate to determine with any certainty the specifics of a proposal to develop post-acute care bundled payments; however, the prevalence of proposals for post-acute care bundled payments from the President, lawmakers, and government agencies strongly suggest that some plan for post-acute care bundled payments would be included in final versions of national health reform bills. The content of this draft bill highlights the many issues that the Secretary would need to consider in implementing the post-acute care bundle and also the many open questions that bundled payments would raise for acute care and post-acute care providers. For a larger discussion of some of the issues involved in post-acute care bundled payments, contact one of the authors for a copy or our white paper To Bundle or Not to Bundle: Lawmakers Explore the Question.