[Congressional Record (Bound Edition), Volume 145 (1999), Part 8]
[Extensions of Remarks]
[Page 12030]
[From the U.S. Government Publishing Office, www.gpo.gov]



 MEDICARE MODERNIZATION NO. 8: SETTING THE GOAL OF MOVING TO A SINGLE, 
          UNITED P.P.S. SYSTEM FOR POST-CARE HOSPITAL SERVICES

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Tuesday, June 8, 1999

  Mr. STARK. Mr. Speaker, as part of a series of bills to provide for 
the modernization of Medicare, I am today introducing a bill to set the 
goal that by the year 2010 Medicare develop and use a single, united 
prospective payment system for post-acute hospital services.
  Currently, payment for post-acute care is a Tower of Babel, with 
different PPS and non-PPS systems used depending on whether one goes to 
a non-PPS hospital, a skilled nursing home, a home health agency, or 
some other form of therapy. The different payment rates and systems 
greatly increase Medicare's complexity and makes the system vulnerable 
to `gaming'--the placement of a patient where the provider will get the 
most money, not where the patient will get the best care.
  The Congressional advisory commission MedPAC, and other health 
experts, have long-warned that the proliferation of payment systems 
makes it evermore difficult for us to know what we are buying and how 
well patients are being treated.
  But moving to a single, unified, and simpler system is not easy. In 
many areas, the data or basic research is not available. Therefore, my 
bill sets out a long-term goal for Medicare to move in this direction. 
I hope that HCFA can develop these simplifications and cross-
comparisons sooner, but if not, the bill sets a `hammer' of requiring 
the provider communities and HCFA to come together to achieve this goal 
by the end of the next decade.
  In the long run, this effort should yield savings and improve quality 
measurement. My introduction of this bill is a signal that this is the 
direction we should be moving.
  Following are some quotes from the March 1999 MedPAC report to 
Congress on why this wonky issue is also an important issue:

       To guide the development of consistent payment policies 
     across post-acute care settings, MedPAC recommends that 
     common data elements be collected to help identify and 
     quantify the overlap of patients treated and services 
     provided. Further, it is important to put in place quality 
     monitoring systems in each setting to ensure that adequate 
     care is provided in the appropriate site. We also support 
     research and demonstrations to assess the potential of 
     alternative patient classification systems for use across 
     settings to make payments for like services more comparable. 
     . . 
       A lack of readily available data on patient function and 
     health status limits the ability to identify where 
     differences and overlaps in patients occur and to compare 
     costs and payments across provider types. In particular, 
     policymakers are concerned that payment policies may furnish 
     incentives for providers to place patients in settings for 
     financial, rather than for clinical reasons. A core set of 
     common data about patients in all post-acute care settings 
     will improve considerably the ability to monitor and make 
     policy decisions about post-acute care.

     

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