3 minute read
Letter from the Chair
Robert Krug, MD President and CEO Mount Sinai Rehabilitation Hospital Medical Director, PM&R Service Line
Ripple Effects
2020 marks a pivotal year for post-acute care (PAC) providers across the Medicare program. As of federal fiscal year (FY) 2020, inpatient rehabilitation hospitals and units (IRFs) transitioned to a new case-mix group payment system, and the Centers for Medicare and Medicaid Services (CMS) now pays skilled nursing facilities (SNFs) under the new PatientDriven Payment System (PDPM). Home health agencies (HHAs) also started a new payment system that is similar to SNFs (called the Patient-Driven Grouping Model, or PDGM), effective January 2020.
CMS has asserted that the recent changes in the SNF and HHA payment systems are part of the overarching effort to move away from fee-for-service and toward value-based care. PDPM and PDGM are designed to reimburse based on patient characteristics and medical acuity and not the amount of therapy provided. Medicare’s revamp of these payment systems aims to correct for the perceived overuse of therapy in prior payment years, and instead enhance reimbursement for medical services – such as ventilators and respiratory care. In the immediate aftermath of the policy changes, some providers have already implemented institutional changes to adapt to the new payment incentives of PDPM and PDGM. To that end, trade press has reported at length about SNFs pulling back on rehabilitation services, reducing therapy staff, and allocating more resources to nursing and medical services care.
In the wake of Medicare’s dramatic PAC policy changes, acute-care hospitals and health systems are reevaluating their utilization paradigm for PAC to ensure that patients are receiving the rehabilitation care they need in order to achieve optimal medical and functional recovery. The ripple effects of these changes are just starting to play out in our rehabilitation hospitals and communities, and key questions emerge regarding how and where patients will receive the vital, medically necessary skilled therapy services that are a critical part of their recovery.
In light of the current landscape, I encourage you to evaluate how your organization educates and collaborates with referral sources. The new Medicare PAC policy environment presents a potential opportune time for IRFs to emphasize our unique competencies as providers of high-quality skilled therapy services and medical care, with 24/7 intensive nursing services and physician oversight. Our sector has occupied this space for decades and our experience is evident in the exceptional functional and quality outcomes our patients achieve.
Health systems’ post-acute strategy are and will continue to be affected by PDPM, PGPM, bundled payments, and other yet-unknown alternative payment model that may be coming down the pike. What’s enduring, however, is the need for providers to offer high-quality rehabilitation care to patients who need it. As 2020 moves forward, I hope we can seize the opportunity to do what is in the best interest for the patients and communities we serve, in line with the core mission of AMRPA.
Find new and exciting opportunities in AMRPA’s Career Center.
Our Career Center provides services and resources to help the medical rehabilitation field meet their professional goals. All rehabilitation professionals may browse and apply for jobs at no cost, and AMRPA members will receive discounted rates for posting positions.
Begin by creating your free Career Cast account, which can be found on the top right hand corner of the website. From there, you can upload and manage multiple resumes, browse through hundreds of job postings, and even research salaries of the positions in question! AMRPA members and affiliates may also purchase Posting Packages at a standard, premium, or platinum level.
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