Press Releases

Rehabilitation and Disability Groups Applaud Comprehensive Evidence-Based Stroke Rehabilitation Guidelines

Washington, D.C. – October 6, 2016: The Coalition to Preserve Rehabilitation, comprised of the nation’s leading patient and rehabilitation organizations, participated today in a Congressional Briefing on the American Heart Association/American Stroke Association’s (AHA/ASA) first-ever evidence-based guidelines for optimizing the rehabilitation and recovery of stroke survivors. The comprehensive guidelines, which include 227 recommendations in 41 clinical categories and span 73 pages with over 900 references, are the latest, evidence-based recommendations for stroke rehabilitation care. With nearly 800,000 Americans experiencing a stroke each year, the rehabilitative care a patient receives is critical to their ultimate recovery. The AHA/ASA’s guidelines are a product of the tireless work of a panel of stroke clinicians and researchers and are considered the seminal set of guidelines to address the recovery and rehabilitation of stroke survivors.

To see our full press release, click here.

MedPAC Recommendation on Medicare Site-Neutral Rehabilitation Creates Barriers to Patient Access

Washington, D.C. – March 13, 2015: The Coalition to Preserve Rehabilitation (CPR), which represents leading consumer, disability, and clinician organizations, expressed serious concern over the Medicare Payment Advisory Commission’s (MedPAC’s) recommendation released today to adopt “site-neutral” payment for certain Medicare patients in need of medical rehabilitation following illness or injury. CPR believes the recommendation included in Report to the Congress: Medicare Payment Policy will inappropriately divert patients who need inpatient hospital rehabilitation to less intensive settings such as nursing homes based on their diagnosis alone, and not on their individual, medical or rehabilitation needs.

The MedPAC Report recommends that Inpatient Rehabilitation Hospitals (“IRFs”) and Skilled Nursing Facilities (“SNFs” or nursing homes) receive SNF rates for certain patients with conditions that they assert can be treated in either setting. The policy would apply in 2016 and be phased-in over a three year period. The specific conditions subject to the site-neutral policy would be determined by the Secretary through rulemaking.

“MedPAC’s recommendation on site-neutral post-acute care ignores data demonstrating different outcomes in care provided in different settings,” stated Kim Calder, Director of Health Policy of the National Multiple Sclerosis Society and CPR Steering Committee member. The level of intensity and coordination in rehabilitation hospitals and units is completely different from nursing homes and recent studies have demonstrated significant differences in patient outcomes in these two settings of care.[1]

“By adopting SNF rates for what is actually a higher, hospital level-of-care, this policy would create a strong financial disincentive to serve certain patients.  This will inevitably lead to access problems for medically complex patients who require an intensive, coordinated level of rehabilitation with the 24-hour availability of physicians.  This level of care is simply not available in SNFs,” stated Judy Stein, Executive Director of the Center for Medicare Advocacy and CPR Steering Committee member.

“The site-neutral policy wrongly places cost considerations over the best interest of Medicare beneficiaries,” said Maggie Goldberg, Vice President of Policy and Programs of the Christopher and Dana Reeve Foundation and CPR Steering Committee member. “Any future Congressional consideration of this controversial proposal must consider the long-term impact and unintended costs of diverting beneficiaries away from a setting of care that has been demonstrated to maximize health, function, and independent living.”

“MedPAC asserts that this proposal will result in savings. But without better quality and cost-data across post-acute care settings, we believe this proposal will cost Medicare more in the long run,” stated Susan Connors, President/CEO of the Brain Injury Association of America and CPR Steering Committee member. “As an organization advocating for individuals with brain injuries, we find this proposal to be particularly alarming in terms of the impact on patients.”

The Improving Medicare Post-Acute Care Transformation (IMPACT) Act, which was enacted last year, would collect data across post-acute care setting, enabling policy makers to develop reforms that do not potentially stint on patient care. CPR and its members will continue to encourage Congress to refrain from prematurely implementing a site-neutral payment system before the IMPACT Act data can be collected and analyzed.

“There are ways to reduce the costs of post-acute care without creating access barriers for patients, as the site-neutral policy does. We will be urging Congress to protect access to intensive, coordinated care provided by inpatient rehabilitation hospitals for Medicare beneficiaries,” said Alexandra Bennewith, Vice President, Government Relations for the United Spinal Association and CPR Steering Committee member. “It is critical for Medicare patients to be treated in the settings that will enable them to return to their home, family, work and community in the quickest and most effective way possible.”

The Coalition to Preserve Rehabilitation is a coalition of national consumer and clinical organizations with the goal of preserving access to rehabilitation services. CPR advocates for policies that ensure access to rehabilitative care so that individuals with injuries, illnesses, disabilities, and chronic conditions may regain and/or maintain their maximum level of independent function. CPR’s Steering Committee is composed of the Brain Injury Association of America, the Center for Medicare Advocacy, the National Multiple Sclerosis Society, the Christopher and Dana Reeve Foundation, and United Spinal Association.

[1]“Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge,” Dobson DaVanzo & Associates, LLC, July 2014, available at https://preserverehab.org/advocacy/promote-study-on-the-importance-of-access-to-inpatient-rehabilitation-care/.

Beneficiary and Clinical Groups Oppose MedPAC’s Site-Neutral Post-Acute Care Payment Recommendation

Washington, D.C. – January 15, 2015: The Coalition to Preserve Rehabilitation (CPR), which represents leading consumer, disability, and clinician organizations, expressed disappointment over the recommendation approved today by the Medicare Payment Advisory Commission (MedPAC) to recommend “site-neutral” payment for certain Medicare patients in need of medical rehabilitation following injury or illness. The coalition believes this policy will inappropriately divert patients who need inpatient hospital rehabilitation to less intensive settings such as nursing homes based on their diagnosis alone, not based on their individual medical and rehabilitation needs.

In December, CPR sent a letter to MedPAC, submitted testimony to Congress, and issued two press releases raising serious concerns with MedPAC’s proposal on site-neutrality between inpatient rehabilitation hospitals (IRFs) and skilled nursing facilities (SNFs). CPR sent a second letter to MedPAC earlier this month. These concerns and recommendations were not meaningfully addressed by the Commission before the MedPAC vote.

“Site-neutral payments are a penny-wise, pound-foolish approach, prioritizing short-term cost considerations over long-term patient outcomes,” stated Maggie Goldberg, Vice President of Policy and Programs at Christopher & Dana Reeve Foundation, and CPR member. “MedPAC fails to consider the long-term patient impact of diverting beneficiaries into less intensive rehabilitation settings despite their clinical needs.”

The IMPACT Act calls on the Centers for Medicare & Medicaid Services (CMS) to develop a uniform data set across all settings of post-acute care. “MedPAC’s mandate includes advising Congress on both cost and quality aspects of Medicare,” stated Judith Stein, Executive Director of the Center for Medicare Advocacy, and CPR member. “MedPAC’s site-neutral recommendation does not promote quality and is, at best, premature.  Congress recognized that further data collection is necessary when it passed the IMPACT Act last fall; that work should be completed before any further action on this proposal is taken.”

“We are also disappointed with the lack of transparency MedPAC exhibited in developing this recommendation,” stated Kim Calder, Director of Health Policy at the National Multiple Sclerosis Society, and CPR member. “MedPAC only recently disclosed the twenty-two conditions proposed for site-neutral payments to the public, which limited the opportunity for timely public analysis and comment. In fact, MedPAC had the list of twenty-two conditions available at December’s public meeting, but chose not to distribute it until after the meeting concluded.”

“Rehabilitation physicians and other clinicians have examined the 22 conditions affected by this policy and are alarmed by the failure to recognize patients with comorbid conditions or complications,” stated Sue Stout, Executive Director of the Amputee Coalition. “Not all SNFs offer the same level of care, and with minimal SNF regulations in place, expert opinion by clinicians suggests that amputees and other patients on the list may be placed at risk under this site-neutral proposal,” she said.

It will now be up to Congress whether to adopt MedPAC’s site-neutral payment recommendation. CPR believes that MedPAC’s recommendation is a clear overreach and under-calculation of the real impact on patients.

“CPR will continue to engage in advocacy efforts that will make sure Congress understands the risk patients will face if payments are equalized between inpatient rehabilitation hospitals and nursing homes for certain conditions,” said Alexandra Bennewith, Vice President of Government Relations at the United Spinal Association, and CPR member. “We will continue to educate lawmakers about how patients in inpatient rehabilitation hospitals with a variety of conditions have better outcomes, go home earlier and live longer than similar patients treated in nursing homes.”

Additional background information on site-neutral payments for post-acute care can be found here and here.

The Coalition to Preserve Rehabilitation (www.preserverehab.org) is a coalition of national consumer and clinical organizations with the goal of preserving access to rehabilitation services. CPR advocates for policies that ensure access to rehabilitative care so that individuals with injuries, illnesses, disabilities, and chronic conditions may regain and/or maintain their maximum level of independent function. CPR’s Steering Committee is composed of the Brain Injury Association of America, the Center for Medicare Advocacy, the National Multiple Sclerosis Society, the Christopher and Dana Reeve Foundation, and United Spinal.

CPR Opposes MedPAC’s Site-Neutral Payment Recommendation

Washington, D.C. – December 19, 2014: The Coalition to Preserve Rehabilitation (CPR), which represents leading consumer and clinician organizations, expressed disappointment over the recommendation approved today by the Medicare Payment Advisory Commission (MedPAC) to recommend “site-neutral” payment for certain Medicare patients in need of medical rehabilitation following injury or illness. The coalition believes this policy will inappropriately divert patients who need inpatient hospital rehabilitation to less intensive settings such as nursing homes based on their diagnosis, not based on their individual clinical needs.

“MedPAC made the wrong decision today to achieve cost savings at the expense of vulnerable Medicare beneficiaries who may be denied the intensive and coordinated rehabilitation care they need. Clinicians should determine when a patient needs hospital-level rehabilitation, not financial incentives that essentially bar the door to the appropriate setting of care,” stated Susan H. Connors, president and CEO of the Brain Injury Association of America, and CPR member. “MedPAC’s site-neutral payment policy is based on a false premise. Inpatient rehabilitation hospitals and nursing homes are far from equivalent. They have different regulatory requirements, levels of care coordination and intensity, and achieve different clinical outcomes.”

In a letter sent last week to MedPAC, CPR opposed MedPAC’s proposal on site-neutrality and raised concerns about the lack of transparency in the Commission’s decision to support this policy. These concerns and recommendations were not meaningfully addressed by the Commission before the MedPAC vote.

“As a beneficiary organization, the lack of transparency makes you wonder who, and what kind of Medicare program, MedPAC is intended to serve,” said Judith A. Stein, executive director of the Center for Medicare Advocacy, and CPR member. “MedPAC’s website would not accept our written comments all week and our witness was cut off after only two minutes during the public comment session. Most troubling, however, is the fact that MedPAC commissioners endorsed a proposal that pretends two very different levels of care are the same, and failed to specify which patients will be impacted by their new policy.”

It will now be up to Congress whether to adopt MedPAC’s site-neutral payment recommendation.

“We plan to work with other patient, consumer and clinician organizations to make sure Congress understands the risk patients will face if payments are equalized between inpatient rehabilitation hospitals and nursing homes for certain conditions,” said Alexandra Bennewith, vice president government relations, United Spinal Association. “When going to the Hill next year, we’ll educate lawmakers about how patients in inpatient rehabilitation hospitals with a variety of conditions have better outcomes, go home earlier and live longer than similar patients treated in nursing homes.”

Additional background information on site-neutral payments for post-acute care can be found here.

The Coalition to Preserve Rehabilitation is a coalition of national consumer and clinical organizations with the goal of preserving access to rehabilitation services. CPR advocates for policies that ensure access to rehabilitative care so that individuals with injuries, illnesses, disabilities, and chronic conditions may regain and/or maintain their maximum level of independent function.

Leading Consumer and Clinician Organizations Critical of Attempts to Divert Medicare Patients From Rehabilitation Hospitals Into Nursing Homes

Concerns about the threat to patients raised in a letter to MedPAC and testimony before the House Energy and Commerce Health Subcommittee

Washington, D.C. – December 8, 2014:  The Coalition to Preserve Rehabilitation (CPR), which represents leading consumer and clinician organizations, today raised serious concerns with proposals that would divert patients who need intensive inpatient hospital rehabilitation to less intensive settings based on diagnosis, despite their clinical needs. This concept, which would equalize payments between rehabilitation hospitals and nursing homes for certain conditions, is often referred to as “site-neutral” payment.

CPR submitted a letter to the Medicare Payment Advisory Committee (MedPAC), which is set to recommend this policy approach to Congress later this month, and provided written testimony to the House Energy and Commerce Health Subcommittee, which is holding a hearing today with the executive director of MedPAC. CPR argues it would be a mistake to put cost considerations before the clinical needs of patients.

“Site-neutral proposals are based on a false premise that inpatient rehabilitation hospitals and nursing homes provide the same level of rehabilitation care,” stated Susan H. Connors, president and CEO of the Brain Injury Association of America, and CPR member. “While I appreciate that MedPAC is trying to save money, it should not do so at the expense of vulnerable Medicare beneficiaries who may be denied the intensive and coordinated hospital-level rehabilitation care they need.”

In its letter and testimony, CPR argues that a decision on site-neutral should be delayed until more data is available to examine what the impact will be on patients.

“The theory of site-neutral payments is simply untested and not evidence based,” said Susan Stout, president and CEO of the Amputee Coalition, and CPR member. “Post-acute care reforms should not precede implementation of the IMPACT Act, which was enacted this Summer and will finally provide a chance to analyze comparable data on patient outcomes across different settings. The proposed reform also seems to ignore the most comprehensive study to date that shows patients treated in rehabilitation hospitals have better outcomes, go home earlier and live longer than similar patients treated in nursing homes, including some of those proposed for site-neutral payments.”

While MedPAC is set to vote later this month on its site-neutral proposal, the commission has not publicly released a list of the 17 conditions affected by this policy.

“I’m very concerned about MedPAC’s lack of transparency in its rush to approve a site-neutral payment recommendation. A decision that threatens so many Medicare beneficiaries should not be brokered behind closed doors,” said Judith A. Stein, executive director of the Center for Medicare Advocacy. “To make matters worse, MedPAC is not expected to seek public comment on this proposal at their December meeting until after the vote is scheduled to occur.”

Additional background information on site-neutral payments for post-acute care can be found here.

The Coalition to Preserve Rehabilitation is a coalition of national consumer and clinical organizations with the goal of preserving access to rehabilitation services. CPR advocates for policies that ensure access to rehabilitative care so that individuals with injuries, illnesses, disabilities, and chronic conditions may regain and/or maintain their maximum level of independent function.