HCFA still weighing PPS methodology
HCFA still weighing PPS methodology
Decision to come within the next few weeks
Whether you’re planning a vacation or navigating a drive from your home to your office, you know there is more than one way to reach a destination. The question is, which route will lead to less frustration and save time?
The Health Care Financing Administration (HCFA) faces a similar challenge in setting up a reimbursement mechanism for the prospective payment system (PPS) that takes effect Oct. 1, 2000, for the hospital rehab industry. HCFA is expected to make a decision by May as to whether reimbursement will be based on a per-diem or a per-discharge methodology, a HCFA project leader announced during the 2nd Annual National Forum on PPS for Rehabilitation, held in April in Atlanta.
"We will decide in the very near future which method to use," says Lawrence Wilson, director of inpatient post-acute care at HCFA. Many industry leaders contend HCFA officials made up their minds in the beginning that a per-diem charge system is the way to go, but Wilson says that is not the case. "I can assure you very serious consideration is being given to both sides of this issue," he says. One option being studied is a hybrid approach that incorporates elements of both systems. Wilson did not say how that might work.
Whichever methodology is chosen, the MDS-PAC assessment instrument developed by The Research and Training Institute at Hebrew Rehab ilitation Center in Boston will be used, he says. (For details on this instrument, see the April 12 fax bulletin issued by Rehab Continuum Report. For a copy of the bulletin, call [800] 688-2421. The latest draft can be accessed at http://www.hcfa.gov/medicare/hsqb/mds20/pacte.htm.)
Study sample size may be too small
Work is beginning on the staff time measurement studies being conducted by an Aspen Systems/Muse & Associates team, Wilson says. Aspen Systems is in Rockville, MD; Muse & Associates is in Washington, DC. These studies will develop groups of classification systems that will place types of patients into groups with an assigned reimbursement factor.
The April 15 Federal Register contains a summary of the proposed collection process for the patient classification system the team will develop. HCFA has dubbed the classification system the Rehabilitation Resources Groups, Version 2000.
Following industry criticism of the Aspen/ Muse study’s sample size, HCFA has doubled the sample size to include 100 facilities and 4,000 patients.
The Washington, DC-based American Medical Rehabilitation Providers Association (AMRPA) continues to express its concerns to HCFA regarding the shortcomings of a payment system designed on a per-diem basis, AMRPA executive director Carolyn Zollar, JD, said during the presentation at the PPS conference. "There are serious budgetary implications of a per-diem approach. Over time, the length of stay will float up. Medicare will have to pay more money out, and [eventually] they will have to ratchet down daily per-diem rates. If costs are cut to hospitals, they’ll have to reduce staff," and quality of care will be reduced, Zollar says.
However, Zollar says AMRPA is pleased that the Aspen/Muse staff time measurement studies now will consider nontherapy ancillary costs. And even though the sample size has been increased, she says AMRPA is concerned it still is too small. A sample of 100 facilities using 4,000 patients is small when there are 1,100 total rehabilitation facilities or hospital units, with a total of 325,000 annual cases, she says. "For low-incidence/high-cost cases, these may be undersampled, and the weights may be artificially low."
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