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Written by: Darlene D'Altorio-Jones (1959-2015) on Tuesday, September 20, 2011 Posted in: Inpatient Rehab

On September 19, 2011 the Budget Office released the President’s Plan for Economic Growth and Deficit Reduction, titled  ”Living Within Our Means and Investing in the Future.”

Fairly early in the 80-page report, attention is centered toward the costs of post acute care, stating that  expenditures (and services) have dramatically increased to SNFs, LTCHs and IRFs and that payments are in excess of the costs of providing high quality and efficient care, thereby placing a drain on Medicare.

Oddly, it is not stated that it’s Medicare that has developed the policies in line with cost reporting and budget neutral policies in their quest for PPS systems that set these payments;  but for now we’ll look past that.

Within this plan, “The Administration supports the policies that will save $42 billion over 10 years and improve the quality of care.”

This is followed by four specific post acute care items and the savings in theory they could provide.

–  Adjust payments for certain post acute care providers (no detail) other than to hold payment adjustments rates from 2014 through 2021. Normally adjustments are made annually.  This is the highest chunk of proposed savings at $32 billion.

–  Equalize payments for certain conditions treated at IRFs and SNFs, such as hip and knee replacements, hip fractures and certain pulmonary diseases. Saying this should begin in 2013 and pronouncing that costs are significantly greater now when treated in an IRF. No evidence provided that the payment models are quite different and a capped payment for shorter stays may actually outweigh benefits against daily payments for an extended stay. But at least they are “encouraging care in the clinically most appropriate setting,” saving $4 billion over 10 years.

–  Encourage appropriate use of inpatient rehabilitation hospitals. This proposal recommends returning to the 75% rule that was in effect in 1984. Again, leaving out facts that conditions to gain access were made more strict and therefore adjustments were made to enable access.  Do you think this will include going back to the 1984 conditions of participation to include the Rehab 10 diagnoses rather than the newer Rehab 13? After all, if they don’t, the argument just made in bullet two of treating patients in the most clinically appropriate setting goes out the window. The Medicare & Medicaid SCHIP Extension Act of 2007 that permanently lowered the threshold to 60% will require modification of course.  This by the way is proposed to save $3 billion over 10 years.

–  Adjust SNF payments to reduce hospital readmissions. Stating 14% of patients discharged from SNF return to acute for conditions that could have been avoided.  Those adjustments are proposed to save $2 billion over 10 years.

I personally have only peeked at this portion of the plan so far, but I strongly encourage all to read it from front to back and to direct their attention toward providing facts, figures and discussion on Living Within Our Means and Investing in the Future.  If not,  your future and growth as initially stated could be stunted.