Keeping Pace with a Changing Reimbursement Landscape

Reimbursement policy directly dictates the quality of care in long-term and post-acute settings, requiring a delicate balance between fiscal accountability and administrative feasibility. John Kane, Senior Vice President of Reimbursement Policy at AHCA/NCAL, emphasizes that effective policy development must move beyond siloed government approaches to consider the holistic needs of both short-term post-acute and long-stay populations. The successful implementation of the Patient-Driven Payment Model (PDPM) demonstrates the value of collaborative engagement between industry advocates and federal agencies. However, current challenges persist, particularly regarding the restrictive nature of Medicare Advantage plans and the persistent underfunding of Medicaid. To maintain financial viability, providers must transition toward value-based care models, prioritize episodic care management, and remain actively engaged in the evolving regulatory landscape to ensure resources reach caregivers and residents effectively.