Medicare has come a long way since the program was created in 1965. Back then, when seniors went to the hospital for surgery or another procedure, they remained there to receive their rehabilitation therapy. Today, many will instead be discharged to a skilled nursing center for a short time until they can get back on their feet and return to their homes and communities.
Call it an evolving care continuum—one that meets the changing needs of a dynamic senior population, and an area where skilled care providers thrive.
We’ve gotten smarter since the 1960s in how we treat patients in a high-quality, lower-cost care setting. And when we apply the best that medical science has to offer, we can speed recovery times and contribute to a greater quality of life.
That is certainly true in the areas of physical, speech, and occupational therapies. Skilled nursing care centers today provide therapy for more than 2.4 million Medicare recipients each year to help improve their functional capability following an acute illness or surgery that requires a hospital stay.
A recent government report by the Office of Inspector General (OIG) challenged that assertion, arguing that the current payment system creates an incentive for skilled centers to provide too much therapy.
Looking at costs is, of course, essential. Yet disregarding the value of therapy for patients who have the potential to return home misses the goal we all strive to achieve.
It’s important to understand that skilled nursing centers are required by federal statute and government regulations to provide as much therapy to Medicare beneficiaries as needed to help them attain the highest practicable level of function and quality of life possible. Providers are not given a choice in the matter, and we are more than happy to deliver this care if it speeds recovery. In addition, there are no clinical standards established by the Centers for Medicare & Medicaid Services (CMS) or in academic literature that define the amount of therapy any one person should receive.
Further, patients and families want as much therapy as necessary to improve or maintain their mobility and ability to care for themselves so they are more likely to get back to their lives pre-hospital, where they were living as independently as they could on their own.
Fortunately, this therapy is working. It is getting patients well and back home. The OIG report released earlier this month failed to examine that, as therapy has increased across skilled care providers, the number of recipients healing and returning home has increased. Discharges to community — a reliable indicator of progress — are up 2.4% from early 2012 to late 2014, the most recent data we have. That means in 2014 an additional 53,200 Medicare seniors went home instead of needing long term care as a result of the more intensive therapies they received during a stay in our centers. The Medicare Payment Advisory Commission showed similar trends in improvement in their own analysis released earlier this year.
Finally, a word about reforming the system — a finding that the OIG report says is needed. The profession agrees. Yet payment reform needs to mean more than simply “less of everything.” That approach is short-sighted and robs Medicare seniors of the care and outcomes they deserve.
We believe there is a better way. That’s why we have taken the lead in three key areas:
- In July, the National Quality Forum endorsed our proposal to measure improvement in self-care and mobility outcomes for patients admitted from a hospital to a skilled nursing care center for therapy services. To date, this is the only recognized standard outcome measure in the nation that can be used to determine payments for post-acute rehab. CMS is studying its efficacy.
- The profession strongly backed the IMPACT Act of 2014. This new law will guide the collection of critical information regarding patient outcomes and cost, and help standardize assessments for treatments, such as physical and occupational therapy.
- Our members have developed a new payment reform plan to replace the existing prospective payment system — one that is forward looking and aligns with current trends to move from payments based solely on volume of therapy minutes to ones that capture the true value of therapy being delivered. We feel that’s best reflected in a single episodic payment for an entire Medicare Part A stay, and we will be working with Congress to implement this needed change.
No taxpayer should expect Medicare to pay simply for what is done in a rehab room. They should expect to pay for the results of rehab. The outcomes of our patients are significant and worth pursuing. I’m confident we can work with CMS, OIG, Congress, and all stakeholders in finding a better approach than one based on an arbitrary number of therapy minutes.
Medicare has a long and proud history. Skilled nursing providers want to continue that tradition of excellence through the needed rehabilitation services we deliver each and every day.
Mark Parkinson is the president and CEO of the American Health Care Association/National Center for Assisted Living.