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June 22, 2018

Our take: What you need to know about MedPAC's post-discharge recommendations

Daily Briefing

    By Jared Landis, Managing Director, Post-Acute Care Collaborative, and Lily Rosenfield, Analyst, Post-Acute Care Collaborative

    In its annual report to Congress released on June 15th, the Medicare Payment Advisory Commission (MedPAC) proposed a significant change to the discharge planning process: allowing hospitals to make explicit recommendations to patients to help them identify high-quality post-acute care (PAC) providers.

    Report findings

    According to MedPAC, although discharge to post-acute providers is common—about 40% of Medicare acute inpatients are discharged to some level of post-acute care—there is a wide variety in quality outcomes across providers.

    While many beneficiaries pick the PAC provider closest to their home, this is most often not the highest quality choice. MedPAC found that over 94% of all beneficiaries using the services of a home health agency or skilled nursing facility had at least one other provider within a 15-mile radius with better performance on a composite quality indicator.

    For hospitals, the post-discharge period is important as well, due to value-based payment reforms which hold providers accountable for the expenditures and readmissions that occur in the 30, 60, or 90 days after patients leave the hospital.

    Therefore, MedPAC recommended authorizing hospital discharge planners to recommend specific PAC providers in order to help beneficiaries identify higher-quality post-discharge options. This recommendation creates several key considerations for policymakers moving forward, including:

    • Developing a clear approach to identifying better quality PAC providers, and making quality standards transparent for PAC providers and beneficiaries;
    • Creating policies that would safeguard against conflicts of interest that could arise from the ability to recommend specific providers; and
    • Determining criteria for what defines a quality provider that accounts for variations in quality across markets.

    To help hospitals identify higher quality PAC providers, MedPAC outlined three possible approaches:

    • Flexible approach: Hospitals would be responsible for selecting quality measures, collecting data from PAC providers, and setting required performance benchmarks;
    • Prescriptive approach: CMS would select quality measures, set performance levels, and identify and notify hospitals and PAC providers. CMS would then update the measures as new data becomes available; or
    • Hybrid approach: Policymakers could combine elements of the above two approaches to balance the potential advantages and disadvantages of each

    What you can do

    To understand patients' preferences:

    MedPAC was clear that beneficiaries should retain their freedom of choice in selecting a provider, as they may have concerns that are not reflected in quality measures. To better understand what patients want when considering their post-discharge care, use our resources to learn more about what patients and families look for in a post-acute provider.

    Learn more: Get the blueprint for a successful post-acute network


    This blueprint offers step-by-step guidance on how to build a successful post-acute network during every stage of partnership development, along with examples of resources, expert advice on implementation, and case studies for creating and optimizing your network.

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