Don’t let CMS confuse sound financial policy with sound healthcare policy

The Center for Medicare Services (CMS) has begun committee hearings on whether or not to allow certain health care procedures for residents of skilled nursing facilities, by deciding if they will be reimbursable under Medicare.  Timely care by the right care provider is something every nursing home resident should be able to expect. It is possible, it is effective, and it is proven. But if CMS determines that these services will not be covered, they will effectively deprive residents of potentially life-saving care.

There are two key issues that we believe are imperative. One is a rule that will determine whether or not a care provider can be reimbursed for seeing a new resident upon admission to a nursing home via telemedicine. The other rule would limit the number of times a physician can see a patient from “as needed” to once every thirty days, or possibly once every three days.  

During the Covid-19 pandemic, under emergency authorization, these services were made reimbursable by Medicare. Immediately patients who were being transferred from a hospital to a nursing home were able to be seen by a physician as part of the admission process.  Conditions were evaluated, medications were reviewed and often updated, and proper care plans were initiated. Most nursing home patients who return to the hospital do so in the first 72 hours. Of those, patients who had not been seen at the facility by a physician experienced a mortality rate nearly double that of those that were. In other words, this is literally a matter of life and death. In many nursing homes there isn’t a physician available and it could take days or weeks before one visits the facility. That’s too late. But a physician can see a patient via telemedicine often within hours of being contacted and that makes all the difference.  

The other rule, the “every thirty day” rule, was also suspended since the onset of the pandemic. Because Covid-19 can be so devastating in a nursing home, it was agreed that patients showing signs needed close monitoring and could need to be seen by physician as often as medically necessary.  It had a marked impact. In many Tapestry facilities, there were zero reported deaths from Covid-19. But regardless of whether a patient is suffering from Covid-19 or congestive heart failure, they need treatment and follow up when their condition demands it, not when the billing system allows it.  

CMS is trying to manage a delicate balancing act between sound medical care and sound financial policy. In our opinion, sound medical care IS sound financial policy. Treating people in place before a condition becomes critical, and keeping them out of hospitals to the greatest extent possible has been proven to save both lives and money. I have urged CMS to consider this when they make their ruling and I’m urging everyone else to join me. Let your government leaders hear from you. Let them know that you and your loved ones need this kind of care.

You can leave your comment on this subject by visiting the federal register at www.federalregister.gov/documents/2020/08/17/2020-17127/medicare-program-cy-2021-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part