The Patient Protection and Affordable Care Act (ACA)
Post-Acute Care Bundling
Patient Protection and Affordable Care Act
What This Is
Bundling is a payment methodology that prospectively determines a single payment amount that may cover an inpatient hospital stay as well as defined services immediately post-discharge. The ACA funds Medicare post-acute bundling demonstration and grant projects as well as a national pilot program. The clear projected goal is to make this payment methodology a common requirement.
Variations in types of bundling
- Hospital stay + post-acute care associated with the stay (30 or XX days)
- Post-acute care only (30, 60, 90 days)—speech-language pathology, physical therapy, occupational therapy, and other designated services
- Inpatient stay, including all physician services (Physician services are not covered in traditional hospital prospective payment systems.)
Mechanism for determination of bundled payment amount
- Primary and discharge diagnoses and co-morbidities
- Initial functional assessment
- Age, sex, etc.
- Cross-reference of patient descriptors to average Medicare costs
Expected advantages of post-acute bundling
- Foster efficiency in health care delivery, as experienced in other Medicare prospective payment systems (hospital, home health, and skilled nursing facilities)
- Reduce hospital re-admission rates
- Foster quality improvement
- Stimulate development of evidence-based knowledge
- Reduce cost of an acute care episode and associated post-acute care (In pilot programs, applicant agrees to 2% to 3% payment discount compared to average Medicare payments.)
What This Means for SLPs and Audiologists
- Hospitals will be the most common entity to manage rehabilitation services.
- Hospitals will be motivated to limit rehabilitation services to those that will reduce costs in overall care, including prevention of hospital readmissions.
- Dysphagia services will be in greatest demand of all services rendered by speech-language pathologists (SLPs)
- Motivation for speech-language services will be postponed until after the 30-day post-discharge date. This is similar to historical trends in acute care hospital prospective payment practices through discharge.
- SLPs and audiologists need to demonstrate to hospital administrators the potential value of their services in every chronological stage of care.
Implementation Time Line
The Medicare post-acute bundling demonstration and grant projects, as well as a national pilot program, are to be established by 2013.
ASHA will work with Medicare regulators to ensure appropriate inclusion of speech-language pathology and audiology services in bundled payment models.