Nursing home alliance offers recipe for post-acute system reform

As lawmakers debate the ingredients of a deal to avoid the fiscal cliff, a long-term care membership organization offers a recipe for post-acute system reform that can be adapted for all sectors of healthcare.

In a media conference call on Wednesday, the Alliance for Quality Nursing Home Care presented its “Three Pillars of Post-Acute Reform,” a policy outline that the Alliance hopes can “rationally” construct meaningful policies.

[Also: Skilled nursing facilities face $782M in cuts under sequester]

“If we’re really to rationally consider how to move forward in an environment that straight cuts simply don’t work,” said Alan Rosenbloom, president of the Alliance, “how do we construct meaningful policies within whatever framework of savings emerges that benefit patients, that rationally provide care of services across the post-acute spectrum and that save the U.S. taxpayers money?”

The Alliance suggests that meaningful post-acute system reform must be based on the following three “pillars”:

1. Patient need must drive payment system reforms. “We believe that patients … have to be in the forefront so that we’re aligning patient characteristics and their care needs with an integrated post-acute delivery system and payment models that are related to that integrated post-delivery (system),” said Rosenbloom. “In other words, trying to be sure that we’re creating a set of aligned incentives rather than a set of mixed incentives to encourage care for patients being provided in the best clinic setting appropriate to their needs at the lowest cost to the Medicare program.”
2. Payment systems must be tied to comparative quality performance. For this to truly work, performance measures must be better balanced to apply across care sectors, noted Dan Mendelson, president of Avalere Health, during the conference call. “We are going to need metrics that are not only specific to post-acute care but also cut across the different modalities, if you will, so you can see the value of post-acute care in context of actually caring for the patient.”
3. Payment to providers must be adequate. Adequate payment is an obvious proposition but not necessarily an easy one to accomplish in these cost-cutting times, Rosenbloom said, but is doable if policies are properly structured. “We feel it’s so important to avoid a simply meat ax kind of ‘let’s cut everybody and let’s cut everybody without regard to the current situation that different kinds of providers might face’ rather than combining the need for savings with rational policy development,” Rosenbloom said.