Hearing of the House Health Subcommittee of the Energy and Commerce Committee - Medicare Post-Acute Care Delivery and Options to Improve It

Hearing

Mr. Chairman, thank you for calling today's hearing on post-acute care delivery. Thank
you to all of our witnesses for coming to testify. I want to especially welcome Dr. Steven
Landers from New Jersey -- who is the President and CEO of the Visiting Nurse Association
Health Group.

The Affordable Care Act (ACA) has put Medicare on a path towards post-acute reform,
however there is still much more that needs to be done. Our committee clearly has a role to play
in advancing positive, beneficiary-focused reforms related to post-acute care for Medicare
beneficiaries.

We have a Medicare system right now with misaligned incentives, inaccurately priced
payments, and little information on the quality or outcomes of beneficiaries served by post-acute
providers like skilled nursing facilities, home health agencies, long term care hospitals, or
inpatient rehabilitation facilities.

In 2013, Medicare spent about $59 billion on post-acute care providers. I believe that
there are viable payment solutions in this sector that are more sensible than increasing costs for
beneficiaries with average incomes of only $22,500.

What we know is that the quality, outcomes, and costs of post-acute care has a lot of
variation around the country. And as a result of the ACA, Medicare is currently testing a number
of payment system reforms that will help improve care and outcomes in this area.

Meanwhile, the need for post-acute care is not well defined. Research has shown the
similarity of patients treated in different post-acute care settings. A patient being rehabilitated
from a stroke or hip replacement can be treated in a skilled nursing facility (SNF) or an inpatient
rehabilitation facility (IRF), but in the latter, Medicare pays 40 to 50% higher than it pays a
skilled nursing facility for the same services. We do not have any common and comparable data
across PAC providers, to determine which patients fare best in which settings, or even what
appropriate levels of care are for patients of varying acuity. That is why, last year, Congress
passed the bipartisan IMPACT Act, which, for the first time, requires providers to report
standardized assessment data across the various post-acute care settings.

While there are many interesting policy ideas in this arena, we need to learn from the
ACA efforts underway and the data being collected as a result of the IMPACT Act and provide
enough time to ensure the models work in a way that doesn't compromise access to high quality
services for our beneficiaries.

Data collected by the IMPACT Act coupled with MedPAC's recommendations that
Congress could better align post-acute care incentives to better utilize Medicare dollars should be
a useful guide for our efforts. Once we have improved information on post-acute care, I look
forward to working with my colleagues on the Committee to find policy solutions to ensure that
Medicare continues to provide quality and effective health care to our seniors.

Thank you.

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