ProPAC suggests single DRG payment
ProPAC suggests single DRG payment
You may see more talk about a single DRG payment in the future. The idea was recently floated out by the Washington, DC-based Prospective Payment Assessment Commission (ProPAC) in its annual report to Congress as a way to curb rapid growth in Medicare spending for post-acute care.
"Given the relationship between acute hospital admissions and post-acute care provider use, Medicare could consider linking these payments," the June report states.
The commission says bundling payments for each episode of care may lead hospitals, skilled nursing facilities (SNFs), rehabilitation units, and home health care operations to deliver care in the most efficient setting.
Under the current rules, hospitals rapidly transfer patients into SNFs whenever possible to decrease hospital length of stays and provide relief for these money losing cases.
Hospitals with their own SNF gain in these situations because Medicare per diem reimbursements, plus the Medicare fee-for-service and ancillary service reimbursements, pay for a SNF-level quality of patient care closely equivalent to the care provided on an acute hospital floor.
In short, there is an incentive to keep patients as long as possible in the SNF and no incentive for organizations involved to coordinate care better.
[Editor’s note: Hospital Peer Review will explore the potential impact and the likelihood of this proposal in future issues.
For your free copy of Medicare and the American Health Care System Report to Congress, contact ProPAC at 300 Seventh St., SW, Suite 301-B, Washington, DC 20024. Telephone: (202) 401-8986.]
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