Under the Patient Protection and Affordable Care Act, a pay-for-reporting system for long-term care facilities must be in place by 2014. The commission recommends that quality measures should include process, safety and outcome measures and should be comparable to those used in other post-acute care settings. "The next step should be pay-for-performance."
In its executive summary, the commission says that these increases or limits "will not solve the fundamental problem with current Medicare fee-for-service payment systems – that providers are paid more when they deliver more services without regard to the quality or value of those additional services." It says payment reforms, such as imposing penalties for excess readmission rates and linking a percentage of payment to quality outcomes, such as those called for in healthcare reform legislation, "need to be implemented."
And, the commission says, "delivery system reforms, such as medical homes, bundling, and accountable care organizations, need to be tested and successful models adopted on a broad scale."