Skilled nursing facilities and inpatient rehabilitation facilities should receive the same payments for treating certain conditions, the Medicare Payment Advisory Commission recommended in its latest report to Congress.
MedPAC has long shown support for equalizing IRF and SNF payments, and the group provided an in-depth consideration of the potential policy in the report released Friday. While IRFs must meet more stringent guidelines than SNFs in areas such as staffing, the two settings treat similar patient populations and achieve similar outcomes, the analysis determined.
The panel examined the possible effects of site-neutral payments for three conditions: rehab after stroke, major joint replacement and hip/femur procedures. Patient characteristics and outcomes were very similar for the orthopedic conditions, but more variable for stroke rehab. For instance, SNFs tend to treat stroke patients at risk for falls, while IRFs see more individuals with swallowing issues.
Leveling these post-acute payments would potentially save the Medicare program money, because IRF reimbursements exceed SNF payments by as much as 50%, MedPAC noted. Rehab facilities have protested the proposed changes, but they might not take a substantial hit to their bottom lines, according to the report. This is because the site-neutral policy would not affect add-on payments, such as monetary reimbursement around having a teaching program, which many IRFs receive.
Click here to access the complete report.