MedPAC discusses PAC research, emergency care policies

The Medicare Payment Advisory Commission today reviewed its upcoming research on payment for a defined episode of post-acute care, which augments its prior development of a common prospective payment system for home health agencies, skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals mandated by Congress. The analysis will initially focus on payment for episodes with up to two PAC services within seven days of each other and exclude hospital and physician services. MedPAC staff also reported on related work to develop two measures for comparing outcomes across the four PAC settings: a composite measure of general acute-care hospital admissions and readmissions; and a discharge to community measure that includes mortality and readmission rates within 31 days. They expect to provide an update on the research next spring. In another session, commissioners discussed policy issues related to urgent care centers and emergency departments, including the role UCCs play and the overlap between UCC and ED patient populations. They also discussed the coding of ED visits and an analysis showing coding has shifted toward higher levels. To address the shift, staff proposed using a single code for ED evaluation and management visits or creating national coding guidelines. Most commissioners favored the guidelines option, opposing the single code option.