Medicare Payment Advisory Commission Approves Recommendations For Nursing Homes, Primary Care

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice;  Seniors / Aging;  Caregivers / Homecare
Article Date: 11 Apr 2008 - 5:00 PDT

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The Medicare Payment Advisory Commission on Wednesday voted to approve several recommendations to Congress focused on Medicare reimbursements for skilled nursing facilities and primary care, CQ HealthBeat reports (Reichard, CQ HealthBeat, 4/10).

The commission recommended amending the Medicare payment system for skilled nursing facilities to add a "separate nontherapy ancillary component" that includes prescription drugs and intravenous therapy. MedPAC also recommended revising the therapy component of the system to base reimbursements on "predicted patient care needs" and implementing a provision for "outlier payments" for unusual financial losses. In addition, the commission recommended a proposal under which HHS Secretary Mike Leavitt would require skilled nursing facilities to report diagnosis information, dates of services on claims filed and "services they furnish separately" on patient assessments. Facilities with the highest profits would receive the largest payment cuts, while those losing money would receive the largest increases (Kaiser Daily Health Policy Report, 3/11).

The commission also recommended an increase in payments to physicians designated by Leavitt as primary care-focused practitioners in an attempt to address a growing shortage of such physicians, CQ HealthBeat reports.

In addition, MedPAC considered a recommendation to establish a pilot program that would provide Medicare beneficiaries with a "medical home" to oversee their care. Under the proposal, physicians would be required to establish their capability to provide primary care; coordinate preventive, maintenance and acute health care services; employ health care information technology for active medical support; conduct care management; provide access and communication to patients at all times; and keep updated records of patients' advance directives, including the types of treatments they should receive if they are incapacitated.

MedPAC in June will formally present the recommendations in a report to Congress (CQ HealthBeat, 4/9).

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