MedPAC fails to endorse coverage of recovery care
Demonstrations could signal need to re-evaluate
Despite a report from the Medicare Payment Advisory Commission (MedPAC) that doesn’t support Medicare coverage of extended recovery care, the industry is moving ahead and might even offer a demonstration project, says Kathy Bryant, JD, executive director of the Federated Ambulatory Surgery Association (FASA) in Alexandria, VA.
MedPAC’s report makes the following recommendation: "At this time, there is insufficient evidence to support a change in Medicare payment policy for postoperative care." However, the report left the door open for future coverage by Medicare: "If, in the future, data from two ongoing demonstration projects [in Illinois and California, which were completed recently] or other sources support coverage of post-surgical recovery care centers, Medicare policy for these facilities should be re-examined." (For information on ordering the report, see "Resource" at end of article.) MedPAC is an independent federal body that advises Congress on issues affecting the Medicare program.
The California report might have limited value because several of the participants dropped out, Bryant points out.
While FASA would have preferred a positive recommendation from MedPAC, Bryant was reluctant to label the report a "setback." The hearings on the report allowed significant visibility of extended recovery care for a number of high-ranking federal officials, she says. Also, the effort gave several ambulatory surgery officials, including Bryant at FASA, Larry Pickner, MD, president of the San Diego-based American Association for Ambulatory Surgery Centers, and Mark Mayo, executive director of the St. Charles-based Illinois Freestanding Surgery Center Association, the opportunity to join forces and promote recovery care to MedPAC.
Bryant expressed disappointment in the report’s comparisons of recovery care and hospital care. "When they said there are no data to compare safety in recovery care and safety in a hospital, we said there are no data to say a hospital is as safe as recovery care," Bryant says.
She points out that it’s clear recovery care costs less than a one-night stay in a hospital, "but it’s much more difficult to show how the availability of recovery care would affect the hospital industry. We simply don’t have access to data on the hospital industry." (For more information on recovery care costs and other issues, see Same-Day Surgery, August and September 2000.)
While FASA might sponsor a demonstration project for extended recovery care, Bryant is reluctant to pick any one strategy at this point. "Part of it depends on where we think Medicare is going and what the limitations will be in the future," she says. "With a new administration coming in, it’s difficult to determine the best approach to promote recovery care."
The bottom line on whether to offer extended recovery care hasn’t changed, Bryant maintains. "Prior to this report, there was no Medicare coverage and no reason to suspect that there would be in the short term," she says. "If you’re doing short-term recovery care centers, you have to have a financially viable center without Medicare patients, and that remains the same."
Resource
To order a complimentary copy of Report to the Congress — Medicare Payment for Post-surgical Recovery Care Centers, contact: Medicare Payment Advisory Commission, 1730 K St. N.W., Suite 800 Washington, DC 20006. Telephone: (202) 653-7220. Fax: (202) 653-7238. Web: www.medpac.gov.
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