The Medicare Payment Advisory Commission today discussed how Medicare could pay for sequential services under a post-acute care prospective payment model, and modify the discharge process for general acute-care hospitals to encourage beneficiaries to use higher-quality PAC providers. The Improving Medicare Post-Acute Care Transformation Act of 2014 requires the development of a PAC prospective payment system but did not authorize its implementation. Commissioners called for developing a bundled payment approach under a PAC PPS as a way to address payment for sequential services, including who could manage the bundle, such as the referring hospital, the first post-acute site of care following a hospitalization or an independent, non-provider entity. On discharges, they addressed the factors affecting hospital protocols and post-hospital placement decisions, and expressed broad agreement that beneficiaries should receive more education during the discharge process. Instead of endorsing a particular approach to increase use of higher-quality post-acute care, the commissioners decided to include in their June report to Congress a chapter on key variables affecting the discharge process, pros and cons related to different approaches, and lessons learned from accountable care organizations and Medicare Advantage plans. In other sessions today, commissioners discussed a draft recommendation to allow rural hospitals that are more than 35 miles from another ED to convert to a stand-alone ED, be paid under the outpatient PPS, and receive annual payments to assist with fixed costs. They also discussed a recommendation to reduce evaluation and management payment rates for off-campus stand-alone EDs within six miles of an on-campus hospital ED, either using a flat 30% reduction or by paying the “Type B” ED rates.
 

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