Proposed post-acute reimbursement changes could have a significant effect on the finances of rural hospitals, suggests a brief from The Cecil G. Sheps Center for Health Services Research at The University of North Carolina at Chapel Hill.
Researchers outline various proposed changes with potential effect on rural hospital finances, including:
- Shifting CMS payment models toward value-based care and bundled payments;
- Increasing pressure from ACOs on rural providers to meet quality and cost goals;
- And the recommendation from the Medicare Payment Advisory Commission that CMS create a single post-acute care provider prospective payment system "based on patient characteristics rather than site of service."
"These changes will increasingly affect Medicare reimbursement of rural hospitals if the number of rural PAC and hospice care providers included in ACO and bundled payment contracts drops, or if more rural residents choose to receive PAC and hospice care in urban centers rather than closer to home," the brief states.
For the brief, researchers used Medicare cost reports to study the scope of post-acute and hospice care provided in rural hospitals or areas.
Here are three findings from the brief.
1. The study found nearly all critical access hospitals provided swing bed services and received Medicare revenue for those services between 2012 and 2015. However, researchers said less than 25 percent of CAHs reported revenue for home health, skilled nursing facility and hospice services.
2. Researchers said rural prospective payment hospitals provided home health and swing bed services more commonly than other types of PAC between 2012 and 2015. Additionally, they said, prospective payment hospitals "were much more likely than CAHs to report no post-acute or hospice care."
3. CAHs received more mean Medicare revenue in 2016 than 2012 for swing bed and hospice services. However, the CAHs reported lower mean Medicare revenue in 2016 than 2012 for skilled nursing facility, home health and inpatient rehabilitation facility services.
Access the full report here.
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