In a 5-page letter to the chairman of the Medicare Payment Advisory Commission (MedPAC), American Medical Rehabilitation Providers Association (AMRPA) chair Bruce Gans, MD, strongly urged the commission to reject a proposal to implement so-called “site-neutral” Medicare payments, which would not distinguish between inpatient rehab facilities and skilled nursing facilities. The proposal may come up for vote this week by MedPAC.

According to a media release from AMRPA, there are at least four key arguments against site-neutral payments, the first of which is the possibility such payments would place Medicare beneficiaries in jeopardy. AMRPA contends that diverting patients from a less intensive rehab setting in spite of their clinical needs could patients place patients’ health at risk.

Prioritizing cost considerations over patient outcomes is another potential problem AMRPA associates with implementation of site-neutral payments. The association reports that data about the long-term impact of rehab hospitals and nursing homes on patients is dissimilar. AMRPA states that a recent study demonstrates better outcomes are associated with treatment provided by rehabilitation hospitals.

Another drawback to site-neutral payments could be failure to acknowledge the significant clinical difference between rehabilitation hospitals and nursing homes, according to AMRPA. The association asserts that while rehabilitation hospitals and nursing homes may have some common features, the care they provide is unequal. While rehabilitation hospitals must meet stringent criteria to be licensed as a hospital, there are virtually no regulations that set quality standards and proper medical supervision for rehabilitation provided in nursing homes, according to AMRPA.

And, finally, AMRPA points out that basing decisions on the “site-neutral” theory could be problematic because that theory is untested and not evidence-based.

The complete letter from AMRPA’s to MedPAC can be seen here.

[Source: Medicare Payment Advisory Commission]