AMRPA tackles Medicare reimbursement issues
Task force calls for changes in rehab PPS
A task force of the American Medical Rehab Providers Association (AMRPA) has proposed changes to the Health Care Financing Administration's (HCFA) prospective payment system (PPS) for medical rehabilitation.
Under the Balanced Budget Act of 1997, HCFA must implement a prospective payment system for medical rehabilitation effective Oct. 1, 2000. The system is to be phased in over two years.
Although no final decision has been made on the rehab PPS, HCFA officials strongly favor a single reimbursement system for the post-acute market using the Minimum Data Set (MDS) as a data collecting tool and basing payments on Resource Utilization Groups III (RUGS), which are being used for the skilled nursing facility PPS. HCFA is working on modifying MDS and is modifying RUGS for the rehab PPS.
The AMRPA task force, which is chaired by Ken Aichison, president of Kessler Institute for Rehabilitation in West Orange, NJ, has recommended AMRPA work with HCFA to develop a PPS for rehab that will better reflect the type of patients treated by rehab and will be in the best interest of the patients served.
The recommendations include:
· Basing payment on a per discharge rather than a per diem basis.
The task force concluded a per diem system would discourage greater intensity of service per day and encourage longer lengths of stay while a per discharge payment system would provide incentive to improve efficiency in treating patients.
If rehab providers tend to keep patients longer under the per diem system, HCFA would be likely to cut per diem rates to stay within its budget. (Congress has mandated that the entire amount spent for reimbursement under the PPS must be 2% less than the current rehab reimbursement amount.)
"A one-day increase in the average LOS under a per diem PPS would increase Medicare spending by about $200 million. This would likely produce cuts in per diem rates, imposition of LOS limits, or both," Aichison wrote in his report.
· Adopting the MDS as the patient assessment instrument with the addition of diagnosis and motor ability items included in the Func tional Independence Measure (FIM, administered by the Uniform Data System for Medical Rehabilitation in Buffalo, NY) and not now part of the MDS.
This modification would change the MDS, which is oriented to nursing home patients, to reflect the characteristics of rehab patients. The task force report stated that UDS officials have said they have no objection to incorporating the FIM into the MDS.
· Basing case weights on analyses reflected in the report from the Santa Monica, CA-based RAND Corporation, which developed the case weights based on a database from more than 350 rehab providers.
The staff at AMRPA are meeting with offi c- ials from HCFA and other agencies and trade groups to discuss the task force report, according to Carolyn Zollar, JD, general counsel for AMRPA, which is a Washington, DC-based organization.
These are the legislative priorities as set out by the AMRPA membership at a membership meeting in March:
· Pursuing the PPS for rehab as set forth by the PPS task force.
· Seeking repeal of the transfer provision of the Balanced Budget Act of 1997 that limits the reimbursements to an acute care hospital if it transfers patients to a post-acute provider. (For details, see Rehab Continuum Report, March 1998, p. 29.)
· Seeking repeal or mitigation of the changes in incentive payments and reimbursement for capital expenditures under the Tax Equity and Financial Responsibility Act of 1982 as outlined in the Balanced Budget Act of 1997.
· Promoting specific consumer protection legislation.
· Supporting repeal of the $1,500 cap on outpatient rehabilitation therapy services. AMRPA has joined a coalition of seven other rehab professional associations in seeking that repeal.
[For more details on AMRPA's activities or for membership information, call (888) 346-4624. The organization's information line is (888) 802-5712; its fax information line is (888) 632-8023.]
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