Congress considering repeal of Medicare transfer rule
Balanced Budget Act provision could have adverse effect on rehab
Rehabilitation providers are being urged to support a measure that would repeal a provision of the Balanced Budget Act of 1997 and could have an adverse effect on the provision of patient care. H.R. 2908, introduced in the last days of the 1997 legislative session by Rep. Jim Nussie (R-IA), repeals the newly revised definition of transfer for Medicare patients that would go into effect Oct. 1 of this year.
Subacute providers have opposed the new definition because of concerns that patients may be referred home without care or remain in acute care for inappropriately long periods of time before they are referred to rehabilitation, says Carolyn Zollar, JD, vice president for government relations of the American Medical Rehabilitation Providers Association.
The bill repealing the transfer definition has been referred to the House Ways and Means Committee and the House Commerce Committee. Zollar and the association’s board of directors are asking rehab providers to contact their representatives about the bill and urge them to co-sponsor it, particularly if their representatives belong to one of the two committees.
Under the old definition of transfer, moving patients from a prospective payment system (PPS) hospital to a post-acute provider is defined as "discharge" from the hospital. Transferring patients from one PPS hospital to another PPS hospital is defined as "transfer." Hospitals receive the full diagnosis related group (DRG) payment for patients who are discharged. They receive a per diem rate for transfers if the patient stays less than the average length of stay.
Under the proposed amendment, the definition of transfer has been expanded to include moving a patient from a PPS hospital to all post-acute care settings skilled nursing facilities, PPS-exempt rehab hospitals and units, or home health agencies for up to 10 DRGs, which will be designated by the Secretary of Health and Human Services. The PPS hospital would be paid only a portion of the PPS rate if the patient experienced a stay of less than the average length of stay.
Rehab referrals may dry up
Rehab providers should be concerned about the change because it may prompt PPS hospitals to keep patients longer to maximize their payments, Zollar says. Hospitals may delay referring patients to rehab or may not refer them at all, she adds.
Because patients tend to achieve better outcomes when they receive rehabilitation as soon as possible after they’ve had an injury or illness, referral delays and refusals would have an adverse affect on patients’ rates of gain and total functional gains.
The Balanced Budget Act provision "would produce financial incentives to distort clinical judgment," Zollar explains. "It would encourage retention of patients in PPS hospitals past the point where discharge to rehabilitation is more appropriate, would discourage appropriate referral of patients for hospital-level rehabilitation services, and would encourage discharge to home without care.
"None of these outcomes would benefit patients or result in lower outlays for the Medicare program."
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