MedPAC presents alternate options to efficiency measurement in a uniform post-acute incentive program – Information

A congressional advisory body tasked with developing a unified program for post-acute value incentives is struggling to set fair benchmarks for all healthcare facilities given different patient conditions and socio-economic needs that may vary from region to region.

The Medicare Payment Advisory Commission met Friday to discuss their upcoming mandated report on the Value Incentive Program and review various metrics. Employees spent months reviewing data points that could be linked to outcomes to adjust reward incentives for vendors facing greater challenges in meeting performance goals.

The Post Acute Care Value Incentive Program (PAC VIP) would apply to all qualified nursing services, long-term hospitals, inpatient rehabilitation facilities and home health facilities in a way that is “compatible” with the proposed SNSF value incentive program.

Models presented to the advisory board on Friday rated performance based on hospital stays, Medicare spend per beneficiary, and successful community discharge.

It also calculated opportunities to form peer groups through which performance awards are paid. Service providers could be assessed on the basis of their proportion of residents with dual entitlements or on socio-economic characteristics related to the postcodes of the patients.

“Peer grouping would help counteract the disadvantages of some SNSFs,” said Carol Carter, co-author of the models.

One challenge with using one of the proposed peer groups, however, is that neither dual eligibility nor zip code assignment is tied to poorer performance in long-term care hospitals, which means it could not be applied to the Value Incentive Program.

One member suggested that the Postcode Measure developed at the University of Wisconsin and developed at the University of Wisconsin, the census-based Area Deprivation Index, would not necessarily capture the challenges in rural areas. The measure tracks 17 social risk factors, including owning a car (for accessing appointments and picking up prescriptions) and phone use (for follow-up care and scheduling).

However, Lynn Barr, executive chairwoman of Caravan Health in Kansas City and a former committee on government affairs for the National Rural Health Association, noted that “everyone” in rural areas has a car and a phone. The measure may not reflect the challenges in these areas, she said, and instead urged staff to consider interventions by the federal organization for quality improvement as a basis for peer grouping.

“The statistical problems here are enormous in many ways,” said commission chairman Michael Chernew, Ph.D., professor of health policy at Harvard Medical School. “It’s really difficult. Questions of adaptation to social determinants, what that means, are demanding enough in a sector, let alone in a uniform way. “

Staff continue to look for additional ways to measure patient differences prior to the final report, due to be presented to Congress in March 2022.

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