Medicare home health reimbursement could change

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Medicare home health reimbursement could change

Medicare home health reimbursement could change
Seema Verma, administrator for the Centers for Medicare and Medicaid Services, said in a CMS release that the agency’s proposed home health care payment plan would be “more responsive” to the needs of patients.
If a proposal suggested by the Centers for Medicare and Medicaid Services becomes effective during the next couple of years, payments for home health care could undergo their biggest change in years.

A CMS press release dated Sept. 25 states that, under the proposal, the home health payment update percentage for home health agencies that submit the necessary quality data for the Home Health Quality Reporting Program would be 1 percent in 2018.

“The proposed rule also includes proposals to refine the [Home Health Prospective Payment System] case-mix adjustment methodology, including a change in the unit of payment from 60-day episodes of care to 30-day periods of care, to be implemented for periods of care beginning on or after Jan. 1, 2019,” the release said. “Additionally, the proposed rule includes proposals for the Home Health Value-Based Purchasing Model and the Home Health Quality Reporting Program.”

 CMS believes the current payment schedule results in the acceptance by providers of fewer patients with chronic illnesses or conditions.

“We’re redesigning the payment system to be more responsive to patients’ needs and to improve outcomes,” said Seema Verma, CMS administrator, in the release. “The new payment system aims to encourage innovation and collaboration and to incentivize home health providers to meet or exceed industry quality standards.”

Under the new system, the Medicare payments to providers would hinge on patient characteristics instead of therapy visits. Such characteristics could include cognitive capacity, functional level, dual illnesses or conditions, and level of severity.

The new payment scheme is expected to reduce home health outlays by $950 million, or 4.3 percent, according to the CMS’ own figures. Critics of the plan believe such a large reduction could impact all benefits, even resulting in the bankruptcy of some home health providers.

Julie Wilson, clinical supervisor at Angels Care Home Health, said there is always concern when the possibility of cuts arises, but many providers have contingencies in place.

“We are one of the largest providers of home health care in the country,” Wilson said. “We do things to be able to continue to serve. We check all our P’s and Q’s and everything is in line. We plan for this all the time, because they make cuts all the time. They’ve made cuts every year I’ve ever worked in this field.”

In a letter to the Tahlequah Daily Press, Shawna Summers of Encompass Home Health in Sallisaw said CMS should have consulted with home health care providers about the proposal

“It doesn’t have to be this way,” she said. “CMS can and should take the time to work with stakeholders to create policies that ensure Medicare home health beneficiaries can continue to access care.”

Since the Affordable Care Act became effective, the expense of Medicare’s home health care payments have risen modestly, but the Medicare Payment Advisory Commission reported in 2015 that therapy accounted for 37 percent of home health visits, up from 10 percent in 1997. Visits by health aides fell from 48 percent to 10 percent over the same span. Skilled nursing was needed for 52 percent of home visits.

The MPAC also reported that Medicare spent $18.1 billion on 3.5 million home health patients through 12,300 providers in 2015.

An attempt was made on Thursday to visit with Tamara Pigeon, R.N., clinical director for Cornerstone At Home Care, but she was out of the office.