MedPAC encourages Medicare beneficiaries to use higher-quality PAC providers

During the Medicare Payment Advisory Commission’s (MedPAC) public meeting on Thursday, March 1, analyst Evan Christman reviewed options for modifying Medicare’s hospital discharge rules to encourage beneficiaries to use higher-quality PAC providers.

Christman pointed out that Medicare assigns responsibility for discharge planning to the hospital, and while part of this responsibility includes providing the beneficiary with a list of SNFs and home health agencies nearby, Medicare regulations don’t require that this list contain quality information. The regulations also currently prevent hospitals from recommending providers.

When analyzing beneficiary choice for a PAC provider versus quality PAC providers nearby, results indicated that most beneficiaries could have chosen a higher-quality alternative nearby (85% had at least one better option, and 47% had five or more).

MedPAC offered three options for assisting beneficiaries in choosing a quality PAC during the discharge process. These proposals include:

  1. Flexible approach: This approach gives hospitals the authority to develop a review process based on criteria that the hospital determines for identifying “higher performing” PAC providers. The criteria for the review process would be based on data collected by the hospital from PAC providers and “other sources.” Discharge planners would then provide this information to beneficiaries when they are selecting a PAC provider.
  2. Prescriptive approach: Medicare would set standards, or one single national standard, that identify(ies) higher-performing providers. The standard would apply to all providers and would include quality measures and benchmarks.
  3. Variant of the prescriptive approach: Medicare would have a uniform definition for quality but set the standards in a way that allows for the variation in provider performance across areas. For example, CMS could establish a two-part test, with the first test determining which providers are in the top quartile nationwide, and the second test determining which providers are in the top quartile of performance compared to all providers in their local market.

Although the adequacy of the data publicly reported on Nursing Home Compare was not addressed during the March 1 meeting, Christman mentioned that “improving this information is another option for addressing discharge planning.”

The discussion surrounding these options is scheduled to continue in June.

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