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McKinley Seeks More Coordinated Care of Seniors Following Hospitalizations

By Kerry Young, CQ Roll Call

May 29, 2015 -- Rep. David McKinley is pressing for an overhaul of how Medicare pays for treatments of people who are recovering from serious injuries and illness, seeking to bring a new level of coordination to the care that patients receive after a hospital stay.

McKinley is far from alone in taking an interest in this field of medicine, known as post-acute care. Both the Energy and Commerce Committee, on which the West Virginia Republican serves, and the Ways and Means panel are taking a closer look at the sector, which is becoming increasingly expensive for Medicare. The program's direct spending on these services more than doubled to $59 billion in 2013 from $27 billion in 2001, according to the Medicare Payment Advisory Commission. This includes payments for stays in skilled nursing centers and inpatient rehabilitation facilities as well as home health services.

Congress last year passed a measure known as the IMPACT Act (PL 113-185) that pushes for more standardization of data collection about how people fare in different post-acute care settings. The information is intended to aid Congress in efforts to reshape Medicare payments for the services.

With his Bundling and Coordinating Post-Acute Care bill (HR 1458), known as BACPAC, McKinley advocates for CMS to move to a bundled payment system for Medicare patients. He wants to carve out a new niche for organizations that can serve as coordinators. These new entities, which might share in any savings that result from a more coordinated approach to care, would help patients and their families navigate the options for people leaving hospitals.

Currently, patients and their families often are confronted by confusing choices about which of several options to pick for this care, such as weighing whether the most intensive therapy offered by inpatient rehabilitation facilities is appropriate or considering what home health services may be available.

Rep. McKinley's bill overhauling post-acute Medicare payments could potentially become part of a larger budget deal if Congress moves to replace budget caps. The bill is likely to generate savings on policies that some members of both parties already have endorsed. The Obama administration included in its fiscal 2016 budget a proposal for putting a bundled acute-care payment in place in 2020, which it estimates could save $9.3 billion over a decade. McKinley envisions even bigger savings from his approach, giving an estimate of $20 billion to $50 billion. An official Congressional Budget Office score on the measure is expected within months.

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