Yes. A unified value-based incentive program for post-acute care providers is recommended with a possible 5% withhold. MedPAC, the Committee that advises Congress on Medicare, is building on their previous work for the unified prospective payment system across four post-acute settings.
The unified value-based incentive program would tie quality to payments for skilled nursing facilities, home health services, inpatient rehabilitation facilities and long-term care hospitals.
The proposed incentive program includes a number of risk-adjusted claims-based measures including all-condition hospitalization within the post-acute care stay, successful discharge to the community and Medicare spending per beneficiary. For more details see our MarketScan Report September 18, 2019: The Focus on Post-Acute Spending Becomes Front and Center with New Payment Models.
The incentive program also accounts for social risk factors by comparing providers with similar shares of dual-eligible beneficiaries. A 5% withhold would fund the incentive payments. But, the Commission said that the number might change based on feedback from its members.
The program would establish a unified value-based incentive program to evaluate providers across a standardized set of measures, including:
- Risk-adjusted, claims-based measures such as Medicare spending per beneficiary
- Uniform performance targets that account for social-risk factors
The value-based incentive encourages increased focus on quality measures, the patient experience, and social-risk factors that might impact performance payments. Recommendations are expected to be finalized next year.
Lisa Remington is president of the Remington Health Strategy Group and publisher of the Remington Report magazine and has worked with more than 6,000 organizations in both a consultancy role and educator. Lisa monitors the complex key trends and forces of change to develop a correct strategic approach to de-risk decision-making and create sustainable futures across the healthcare continuum.