Health Affairs: Unintended Consequences of the PPACA Could Threaten Care for Medicare Patients

Three provisions of the Patient Protection and Affordable Care Act could have unintended consequences on the six million Americans receiving long-term care, according to a new Health Affairs report.

Specifically, the report addresses the Hospital Readmissions Reduction Program, the National Pilot Program on Payment Bundling and the Community-Based Care Transitions Program, all parts of the PPACA. These provisions inadequately address the unique needs among the Medicare population and, in some instances, produce unintended consequences that may attribute to poor outcomes, according to the report.

Here are concerns the report addresses.

• The Hospital Readmission Reduction Program, which was designed to provide incentives for improvements in outcomes, could drive hospitals to limit access to frail older adults who have a higher chance of being readmitted.
• The National Pilot Program on Payment Bundling, designed to motivate providers to deliver low-cost care and avoid expensive post-acute stays, excludes long-term services and support as part of the "bundle." Providers may withhold services to some long-term Medicare patients past the bundled payment period to realize savings.
• Community-based care transitions, intended to link community-based organizations with hospitals to improve outcomes and reduce readmissions, may not be in the geographic region to serve some Medicare patients who might otherwise benefit from the transition services.

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