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.
Currently, Medicare defines Post-Acute Care to include Long Term Care Hospitals (LTCH), Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF), and Home Health (HH).[i]
However, the type and the amount of rehabilitative therapy services provided between these settings varies greatly across the different levels of care. Regulations around patient eligibility, facility documentation requirements, and quality measurements are critical for physiatrists to understand in order to best choose a PAC setting when discharging a patient from acute care and to ensure optimum patient outcomes. Physicians working in any of these settings, including in the acute hospital, are often required to advocate for the appropriate level of care for their patients. This typically takes the form of appropriate documentation and peer-to-peer reviews with insurance carriers or other regulatory agents. This understanding and ability to “care manage” a patient through the post-acute environment is critical for today’s physiatrist to provide true value-based care.
It needs to be recognized by all stakeholders, not just the treating physiatrist, that some of these levels of care do not have the same standards, so that one size or setting may not fit all. The information provided in this toolkit aims to help you talk to your PAC administrators, fellow physicians, and other caregivers about your and your patients’ needs. The information provided in this toolkit will be based on Medicare regulations as Medicare is often the common guide for many payors. An overview of each site’s factors for patient eligibility, facility regulatory requirements, payment (facility and physician), patient measurement tools, and quality reporting will be presented. AAPM&R plans to update these factors regularly as annual regulations are updated. Please follow along here or check back when you need an administrative or regulatory question answered about these PAC settings.[ii]
[i] Medicare Payment Advisory Commission. March 2019 Report, Chapter 7. Cross-cutting issues in post-acute care. http://www.medpac.gov/docs/default-source/reports/mar19_medpac_ch7_sec.pdf?sfvrsn=0. Published March 15, 2019. Accessed May 29, 2019.
[ii] Please note, the information provided will cover basic information, as everyone’s circumstance in their setting may not be one size fits all.