MedPAC report here:
MedPAC Report
Conclusion
The many changes made to the payment system have done little to address the shortcomings of Medicare’s payment system for skilled nursing facilities that were identified soon after the system was implemented. The present payment system continues to encourage providers to furnish clinically-unnecessary services for financial gain. With a number of providers experimenting with various payment reform models, accuracy should remain a central concern since bundled payment and ACO reforms continue to rely on fee-for-service payments. Without changes to the prospective payment system, skilled nursing facilities will continue to have incentive to furnish care that runs counter to broader reforms. Our results confirm that changes more sweeping than those made to date are required. A revised payment system would improve the accuracy of payments to skilled nursing facilities, make providers more neutral to the types of patients they admit, and dampen the incentive to furnish therapy services unrelated to patients’ care needs.
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