President Obama has proposed the idea of “bundling” reimbursements for both acute and post-acute care into a single payment to acute care hospitals. His administration expects bundled payments to reduce readmission rates, improve efficiency and cut Medicare costs by almost $19 billion over the next ten years.

In reality, bundled payments would reduce access to post-acute care services—especially rehabilitation. A bundled payment system creates an enormous disincentive for acute care hospitals to coordinate care with high-quality rehab providers.  After all, if Medicare pays for post-acute care services regardless of whether those services are rendered, what is a hospital’s motivation to seek the highest quality post-acute care for its patients?

Acute care hospitals should not be the primary decision makers in whether post-acute care is needed, and where that care should be provided. Should bundled payments be written into law, I will be deeply concerned for newly disabled patients who will undoubtedly face strong bureaucratic resistance when seeking the rehab services they need. In addition, bundling could have a negative impact on rehabilitation-related research and education.

The rehabilitation industry is working on an alternative to post-acute bundling that would preserve access and ensure quality and efficiency. I encourage you to voice your opinion on this issue and contact your congressman or state representative. Let’s preserve access to rehabilitation for our patients.

Alberto Esquenazi, MD
Chair and Professor, Department of Physical Medicine & Rehabilitation
Chief Medical Officer, MossRehab