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HSM410 Assignment: Please read the Real-World Case Study and answer…
HSM410
Assignment: Please read the Real-World Case Study and answer the following questions in a Word Document.
Medicare’s payment methods are site specific. Each site has its own payment method. Chapters in the textbook describe payment systems for inpatient acute care hospital, inpatient psychiatric hospital, physician offices, hospital outpatient departments, ambulatory surgery centers, four different methods of PAC, and others. Experts contend that this structure of site-specific payment systems inappropriately focuses attention on the site of care rather than on the patients’ characteristics and needs (Pruitt 2013, 1; American Health Care Association 2015, n.p.). However, as the chapters of textbook show, existing Medicare payment systems focus on the site of the delivery of healthcare services, rather than on the characteristics or care needs of the Medicare beneficiary. As a result, patients with similar clinical characteristics receiving similar care and therapies may be treated in different settings and at different costs to Medicare. Additionally, Medicare’s distinct payment systems fail “to encourage collaboration and coordination across multiple sites of care and provides few incentives that reward efficient care delivery” (Pruitt 2013, 1). Finally, the Medicare Payment Advisory Commission (MedPAC) proposes that the Medicare “program should not pay more for care in one setting than in another if the care can be safely and efficiently (that is, at low cost and with high quality) provided in a lower cost setting” (MedPAC 2014, 97).
Site-neutral payment has been proposed as a solution to problems that distinct site-specific payment systems present. Site-neutral payment is paying providers the same amount for similar services provided in different settings. Similar terms for site-neutral payment is “equalizing payments” and “harmonizing payments.” MedPAC explains, “if the same service can be safely provided in different settings, a prudent purchaser should not pay more for that service in one setting than in another” (MedPAC 2013, xii). Importantly, site-neutral payment is proposed as a way to save money both for Medicare and for Medicare beneficiaries.
Federal agencies, the Congress, the President, the MedPAC, and other health policy analysts support the development and establishment of site-neutral Medicare payments. Key events in the background of site-neutral payment include:
Office of Inspector General (OIG) recommended that hospitals performing for ambulatory surgery center-approved procedures in their outpatient surgery departments be paid at the same rate as ambulatory surgery centers (Office of Inspector General 2014, ii).
Centers for Medicare and Medicaid Services (CMS) as early as 2006 planned to conduct assessments and collect data that would lead to site-neutral payments for PAC services (Centers for Medicare and Medicaid Services 2006, 3).
Congress passed the Deficit Reduction Act (DRA) of 2005 and President George W. Bush signed it into law in 2006. Section 5008 of the DRA mandated a demonstration project related PAC payment reform. The project was to lead to site-neutral payments (Centers for Medicare and Medicaid Services 2006, 1).
President Barack Obama’s 2014 and 2016 budgets proposed equalizing payments for certain conditions commonly treated in IRFs and SNFs (2013, 38; 2015, 62).
MedPAC recommended in its March 2012 report that Medicare payment rates should be equal whether an Evaluation and Management (E&M) office visit is provided in a hospital outpatient department or in a physician’s office (MedPAC 2013, xiii). In its June 2013 report, MedPAC noted that Medicare paid 141 percent more for a level II echocardiogram provided in hospital outpatient department than in a freestanding physician’s office (MedPAC 2013, xii). As a result of these differential payments, healthcare services that could be safely provided in a physician’s office are migrating to hospital outpatient departments (MedPAC 2013, xii). For its June 2014 report, MedPAC’s analysts selected three conditions frequently treated in IRFs and SNF (rehabilitation therapy after a stroke, major joint replacement, and other hip and femur procedures, such as hip fractures). The analysts assessed the feasibility of paying IRFs the same rates as SNFs for these conditions. The analysts found that the patients and outcomes for the orthopedic conditions were similar and represented a “strong starting point for a site-neutral policy.” The analysts concluded that additional work needed to be done “to more narrowly define those cases that could be subject to a site-neutral policy” (MedPAC 2014, 94-95).
Bipartisan policy analysts of the Moment of Truth Project recommended equalizing payments between rehabilitation services provided in different settings (Bowles and Simpson 2013, 26).
Chapter 8 describes the four different payment systems for the PAC settings. Each PAC setting, SNFs, LTCHS, IRFs, and HHAs, has its own payment system. In 2016, site-neutral payment will be implemented for LTCHs.
Using the pdf. attached, put paragraph explaining what the Pathway for Sustainable Growth Rate Reform Act is?
Sustainable Growth Document-1.pdf
