The Patient Protection and Affordable Care Act (ACA)

Post-Acute Care Bundling

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's Role

ASHA will work with Medicare regulators to ensure appropriate inclusion of speech-language pathology and audiology services in bundled payment models.

Additional Resources

ASHA Corporate Partners