FutureFocus April 4, 2018 Redistribute Post-Acute Payments Based on Patient Condition

Lisa Remington

In this week’s FutureFocus, is important information about the future of post-acute payments. MedPAC, the committee that reports to Congress on Medicare, is recommending prior to the implementation of the PAC PPS in 2019, that blending the relative weights of the setting-specific payment systems and the unified PAC PPS be considered. We provide the details. This is a must read. In our Washington Report, we provide insight into two alternative payment models for advanced illness recommended by HHS.

Lisa Remington, President, Remington Health Strategy Group

By: Ronald M. Schwartz, Writer, The Remington Report

An expert advisory committee to the Health and Human Services (HHS) Secretary, March 26, took a major step toward advancing two alternative payment models (APMs) designed to support people living with serious and advanced illness. One model was developed by the Coalition to Transform Advanced Care (C-TAC) and the other by the American Academy of Hospice and Palliative Medicine (AAHPM).

The panel--the Physician-Focused Payment Model Technical Advisory Committee (PTAC)—was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)to provide comments and recommendations to the HHS Secretary on physician-focused payment models. The panel’s recommendation sends CTAC’s Advanced Care Model (ACM) and the AAHPM’s Patient and Caregiver Support for Serious Illness Model to HHS Secretary Alex Azar II to approve a Medicare demonstration testing APMs that support beneficiaries with advanced illness.

Background:

Hospice care is not currently covered by MA. Instead, enrollees must move to traditional Medicare if they need hospice services, though MA may cover Part D drugs unrelated to the terminal condition. MA makes up about one-third of the Medicare population. That number is expected to increase in the coming years.

Currently, palliative care makes up one-quarter of Medicare expenditures, only 4% of beneficiaries use it.

In 2014, the Medicare Payment Advisory Commission recommended that hospice benefits become part of MA plans. The Senate Committee on Finance also included a carve-in as part of a bipartisan chronic care proposal,  but it wasn't part of a final plan. Read about the Advanced Care Model (ACM) and American Academy of Hospice and Palliative Medicine (AAHPM)  PACSSI Model.