After the Hospital: Ensuring Access to Quality Post-Acute Care

House Ways and Means Subcommittee on Health

2025-03-11

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Summary

The meeting focused on the crucial topic of ensuring access to quality post-acute care for seniors within the Medicare program. Discussions highlighted the reliance of millions of Americans on these services for recovery and improved outcomes after hospital stays. Key challenges included funding sustainability, administrative burdens, and staffing shortages, while potential solutions like telehealth expansion and payment system reforms were explored. [ 00:32:46-00:32:53 ]

[ 00:33:10 ] [ 00:34:15-00:34:28 ]

Challenges to Post-Acute Care Access and Sustainability

Medicaid Funding Cuts Several speakers voiced strong concerns about proposed cuts of $880 billion to Medicaid, emphasizing its vital role as the primary payer for long-term care for seniors and individuals with disabilities. Such cuts could have devastating consequences, potentially leading to widespread facility closures, particularly in rural areas, and forcing individuals to forgo essential care or face financial ruin.

Medicare Advantage (MA) Prior Authorization Witnesses highlighted how Medicare Advantage plans' prior authorization and denial practices create significant barriers to accessing necessary post-acute care, causing delays in patient transfers and extended hospital stays. These delays can lead to worse patient outcomes, increased costs for acute care hospitals, and frustration for families. [ 01:15:35-01:15:54 ]

Despite frequent appeals, many initial denials are upheld, indicating a systemic issue.

Long-Term Care Hospital (LTCH) Closures and Funding Issues The number of LTCHs has decreased significantly, with closures attributed to outdated payment criteria and a rising high-cost outlier threshold that makes it financially difficult to treat critically ill patients. This situation limits access for patients requiring specialized, extended care, and proposed legislation aims to reform these payment methods and allow direct admissions from critical access hospitals.

Home Health Agency Sustainability Home health agencies face severe financial pressures from reimbursement cuts and increased operational costs, leading to agency closures across the country. [ 02:22:52-02:23:10 ]

Many agencies operate on thin margins, often at a net loss, challenging the sustainability of home-based care despite its cost-effectiveness and patient preference.

Proposed Solutions and Innovations

Unified Post-Acute Payment System (PAC-PPS) The implementation of a unified PAC-PPS, which has been under development for years and has a technical prototype ready, is advocated as a way to streamline payments and improve efficiency across different post-acute care settings. This reform could lead to substantial cost savings for Medicare and potentially reduce the need for prior authorization practices by Medicare Advantage plans.

Telehealth Expansion There is broad support for expanding and reimbursing telehealth services in post-acute care, especially in rural areas, to improve patient access and reduce the burden on scarce healthcare staff. [ 00:33:48-00:34:00 ]

Telehealth is seen as a cost-effective solution for monitoring patients, conducting recertifications, and enabling care in challenging geographic regions. [ 01:52:13-01:52:24 ]

Addressing Staffing Shortages The healthcare system faces critical nursing and CNA shortages, impacting the ability to open beds and provide necessary care. While new minimum staffing standards for nursing homes are controversial, advocates argue they are essential for improving patient safety, reducing adverse outcomes, and enhancing staff retention. [ 02:06:25-02:06:30 ]

Long-Term Care Insurance and Prevention A proposal for a public-private partnership for long-term care insurance aims to address the looming crisis of an aging population needing assistance with daily living, thereby potentially reducing Medicaid expenses. Additionally, focusing on preventative care and wellness is highlighted as a critical strategy to improve outcomes and reduce overall healthcare costs.

Tone of the Meeting

The meeting's tone was marked by serious concern regarding the future of post-acute care, particularly the sustainability of services for vulnerable populations. There was significant partisan contention over proposed Medicaid funding cuts and nursing home staffing mandates, leading to spirited exchanges and differing views on government's role. Witnesses expressed frustration with administrative complexities, regulatory burdens, and the adverse impact of certain Medicare Advantage policies on patient access and provider viability. Despite these tensions, there were collaborative efforts and bipartisan support for initiatives such as telehealth expansion and specific legislative reforms, underscoring a shared recognition of the importance of post-acute care. [ 00:33:48-00:34:00 ]