Bundled Care Plan For Post-Acute Care Re-Introduced

A home health group is pushing the latest version of a bill that would bundle post-acute care payments and allow providers to split savings from coordinated care, though other post-acute care provider groups have raised concerns.

The Bundling and Coordinating Post-Acute Care Act (H.R. 1458), or BACPAC, would bundle pay for post-acute services for 90 days following hospital discharge and promote coordination of care between the discharging hospital and the post-acute care provider responsible for a beneficiary’s care after a hospital stay. The bill creates a condition-related group payment system that would take into account a patient’s illness, age, and physical condition to determine what bundled rate Medicare would pay to whatever type of post-acute care provider beneficiaries head to once released from the hospital. Those providers would then be held accountable for any costs exceeding the bundle, including the cost of any hospital readmission of their patients.

The bill would save Medicare 4 percent over 10 years by requiring HHS to ensure that overall spending doesn’t exceed 96 percent of what the agency currently spends on post-acute care.

Hospitals, insurers, other providers, or third party groups could take charge of a beneficiary’s care coordination and keep the bulk of any savings from the bundled payment. Whichever organization coordinates a beneficiary’s care could take up to 55 percent of any money remaining from the bundle, with the hospital and post-acute care doctors and networks each getting around 15 percent.

Eric Berger, CEO of the Partnership for Quality Home Healthcare, said BACPAC puts a system into place for post-acute care similar to what has been used in hospitals for 30 years and improved efficiencies.

“Once you leave the hospital, nothing like that exists,” he said, adding that the bill would help patients get the right type of care for their condition.

Berger gave the example of two people who have gotten their hip replaced–a 66-year-old woman who is a regular tennis player and an 86-year-old man with dementia. While their care in a hospital may be similar, their recoveries will be different and likely in different settings.

Rather than have Medicare pay different per-day rates depending on the type of post-acute care provider they go to, the amount of the post-acute care bundle would be based on the condition of the beneficiary, regardless of whether he or she receives care in their home or a nursing home.

Berger said the bill aligns the post-acute care industry with other parts of Medicare that are now emphasizing value over volume. The president’s budget contained a similar plan, proposing bundling for all post-acute care providers.

The American Health Care Association, which represents nursing homes, is still reviewing the bill but has some questions about some of the language. A statement from the group did not specify what it’d like clarified, however. The group was supportive of some elements of the bill.
“While we agree conceptually with some components of the measure, we do not support BACPAC in its entirety. For example, the association likes and supports the development of a PAC-only bundled episode, as well as the elimination of the three-day qualifying inpatient stay,” AHCA spokesman Greg Crist said in an email, referencing a beneficiary’s need to stay in a hospital for three days before Medicare will cover nursing home care.

Bill Dombi, vice president of law for the National Association for Home Care and Hospice, said the group is supportive of the idea of post-acute care bundling but has concerns about how this bill is structured. He said not all aspects of a bundle are specifically addressed in the bill. For example, in reference to the condition-related groups in which beneficiaries would be placed, Dombi said it’s “conceptually specific as to what a patient classification model would be in broad terms, but it’s not specific enough for us to think it will work.”

Dombi said NAHC would like to see a post-acute care bundling program based on CMS’ bundled payments demonstration program, which the group supported.

“Examining a variety of options would be a better way to go before making a major change–you start with learning rather than conclusions,” Dombi said.

BACPAC is sponsored by Reps. David McKinley (R-WV), Jerry McNerney (D-CA) and Tom Price (R-GA).

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