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Per-diem vs. per-episode still a bone of contention
The construction of a prospective payment system for the rehab industry continues to draw the ire of industry groups as officials debate the use of a per-episode vs. a per-diem reimbursement for Medicare patients.
Although a spokesperson for the Health Care Financing Administration (HCFA) tells Rehab Continuum Report that no decision has been made on reimbursement design, some industry observers say HCFA is pushing for a per-diem payment scale.
Kenneth Aitchison, president of West Orange, NJ-based Kessler Rehabilitation Corp. and chair of the American Medical Rehabilitation Providers Association (AMPRA) prospective pay task force, says he left a March 3 Technical Experts Panel meeting with the impression that HCFA "absolutely believes per-diem is the way to go. It’s clear that what they’re doing with the staff time measurement studies . . . is being done in such a way that they are not getting information on what to put in place other than per-diem."
The Technical Experts Panel provides input on the work plan, sampling frame, and data collection procedures for the research study by an Aspen Systems/Muse & Associates team, which has the contract from HCFA to develop the patient classification system. Aspen Systems is located in Rockville, MD. Muse & Associates is in Washington, DC.
Aitchison says he is sending HCFA a letter on behalf of AMPRA objecting to the per-diem approach. AMPRA previously has written to HCFA and published information on its Web site advocating the advantages of a per-episode payment system. The organization contends that a per-diem system will generate higher costs because providers will have an incentive to keep patients in the hospital longer.
The HCFA spokesperson says there still is an opportunity to modify the per-diem approach stated in the contract awarded to Muse and Aspen, but the modifications would need to be done before the contractors go into the field to conduct the staff time measurement studies. "Once we go into the field, we’ll have to commit to one way of doing the data," the HCFA spokesperson says.
The HCFA spokesperson stresses that even if a per-diem system is adopted, HCFA will not use the Resource Utilization Groups system currently being used in skilled nursing facilities as a resource allocation tool for a rehab PPS. "We will develop our own system [for rehab facilities]," he says.
The scheduled timeline for the project is as follows, according to HCFA:
Field studies for the staff time measurement studies will begin by June. HCFA plans to send information out to hospitals informing them of how they can volunteer to serve as a test site.
Field work for the staff time measurement project should be completed by the end of the summer, with a draft instrument ready for review by late 1999.
Another Technical Experts Panel meeting will be held in January or February 2000 to review the staff time measurement information.