Major Win - Medicare Payment Advisory Commission (MedPAC) Abandons Efforts to Implement IRF/SNF Site-Neutral Payment
After years of advocacy by AAPM&R and its physician volunteers, the Medicare Payment Advisory Commission (MedPAC) announced in its June 2024 report to Congress that it is halting its work on developing a recommendation for site-neutral payment policies for care provided in the Inpatient Rehabilitation Facility (IRF) setting. This represents a major victory for both providers and patients in the IRF setting and comes after intense, sustained advocacy from AAPM&R and other stakeholders.
In its report to Congress, MedPAC acknowledges that comparing patients treated in IRFs and SNFs and their outcomes was significantly more challenging than expected. For background, MedPAC is an independent legislative branch agency established by Congress in 1997 to advise on issues affecting the Medicare program, including payment systems. On September 7, 2016, former AAPM&R President, Greg Worsowicz, MD testified at the U.S. House of Representatives Ways and Means Committee's Health Subcommittee hearing on Incentivizing Quality Outcomes in Medicare Part A. His testimony placed an emphasis on improving the quality and efficiency of patient care through payment reform measures and value-based purchasing in the post-acute care (PAC) sector.
Over the years, the Academy worked to ensure that physiatry’s voice was taken into account during MedPAC’s ongoing deliberations on this issue and collaborated with other stakeholder organizations to advocate against site-neutral payment proposals and the development of a Unified Post Acute Care Prospective Payment System. These efforts included submitting and co-signing numerous comment letters, participating in multiple Technical Expert Panels (TEPs), meeting with Congressional offices and MedPAC staff, testifying before the U.S. Congress, and creating Principles for a Medicare Unified Post-Acute Care Payment System to advocate for prioritizing patient needs.
On September 7, 2016, former AAPM&R President, Greg Worsowicz, MD testified at the U.S. House of Representatives Ways and Means Committee's Health Subcommittee hearing on Incentivizing Quality Outcomes in Medicare Part A. His testimony placed an emphasis on improving the quality and efficiency of patient care through payment reform measures and value-based purchasing in the post-acute care (PAC) sector.
G2211 Add-On Code
Effective January 1, 2024 the Centers for Medicare and Medicaid Services implemented payment for G2211, a HCPCS add-on code to be billed in conjunction with an office/outpatient evaluation and management (E/M) code in certain instances. Learn more about how to use this resource and applications for physiatry.
AAPM&R Stroke Rehabilitation Toolkit
Stroke remains the second leading cause of death, the third leading cause of death and disability combined, and a leading cause of institutionalization in the world. Developed by the Academy’s Innovative Payment and Practice Models (IPPM) Committee, the Stroke Rehabilitation Toolkit is a clinical and educational resource that AAPM&R members, payers, and health care systems can utilize to develop care structures and alternative payment models (APMs) to allow for the provision of high value stroke rehabilitation care.
This toolkit offers members the tools they need to develop a physiatrist-led stroke rehabilitation APM, in which clinical outcomes and patient satisfaction will improve and costs will be reduced through consistent and direct involvement of physiatry in stroke rehabilitation care across the continuum.
AAPM&R Post-Acute Care (PAC) Toolkit
The Post-Acute Care (PAC) model is in the midst of an evolution. With today’s health care environment placing a greater emphasis on Value Based Purchasing (VBP), payors are examining both the quality and cost of care in PAC. As new payment models are being considered, recognizing the importance of patient oversight within PAC settings is critical.
The information provided in the Post-Acute Care (PAC) Toolkit aims to help you talk to your PAC administrators, fellow physicians, and other caregivers about your and your patients’ needs, and is based on Medicare regulations as Medicare is often the common guide for many payors.