Congress: Improve Medicare home health reforms to protect patient care

When it comes to health care, we expect our treatment decisions to be based on actual observed clinical evidence and real-world data. Yet, a newly finalized home health payment model from the Centers for Medicare & Medicaid Services (CMS) moves away from evidence-based decision making toward dangerous assumptions that could disrupt care for some of our nation’s most vulnerable seniors.

Millions of Medicare patients want to receive care in the comfort of their own homes. We owe it to them and America’s growing senior population to do everything possible to ensure their access to high-quality home health care is not compromised.

{mosads}Unfortunately, this newly finalized Medicare home health payment model, called the Patient-Driven Groupings Model (PDGM), has great potential to threaten the continuity of care for an estimated 3.5 million homebound seniors across the country rely on to remain safely in their homes as they age while protecting their quality of life.

The new payment model – the most significant to home health in decades – makes changes to Medicare reimbursement for home health services based on untested assumptions about providers’ billing behavior, rather than any actual, evidence-based changes triggered by the new payment model that affect overall Medicare spending on home health services. Through these assumed behavioral changes, Medicare is likely to arbitrarily cut reimbursement rates to home health agencies by 6.42 percent – equaling more than $1 billion – in the first year alone.

With more than half of home health agencies bracing for such sharp and unexpected reimbursement reductions, the home health community has raised constructive concern with both CMS and Congress that these cuts may lead to unintended consequences – most notably a disruption in care for beneficiaries requiring home health to prevent expensive rehospitalizations, manage chronic conditions and assist seniors following an acute episode of care.

While the home health community has demonstrated strong support for reforms to align payment with patient characteristics and the removal of utilization-based incentives, it’s critical patient care is protected during a transition of this magnitude. 

Recognizing the serious impact PDGM will have on seniors and on the integrity of Medicare’s home health benefit, a bipartisan group of lawmakers has listened to the concerns of the home health community and responded by engaging in a bipartisan policy solution. Three bills, introduced in the House and Senate, would require Medicare to adjust reimbursement rates only after behavioral changes by home health agencies actually occur, instead of assuming changes might occur and imposing cuts without evidence-based reason.

The bipartisan bills (S. 3545, S.3458, and H.R. 6932), sponsored by Sens. Susan Collins (R-Maine), Debbie Stabenow (D-Mich.) and Bill Nelson (D-Fla.), John Kennedy (R-La.) and Bill Cassidy (R-La.), and Reps. Ralph Abraham (R-La.), Garrett Graves (R-La.), Scott DesJarlais (R-Tenn.), Vern Buchanan (R-Fla.), and Terri Sewell (D-Ala.) would stabilize access to care while CMS and stakeholders work together to improve Medicare payment reforms to ensure the delivery of consistent, clinically effective and high quality home health services.

In addition to requiring reimbursement changes be made on actual changes in billing behavior, these pieces of legislation will limit any necessary rate increases or decreases to no greater than 2 percent per year. This phased-in approach will allow additional time to shelter patients and providers from dramatic rate shifts.

Home health is a clinically advanced, cost effective and patient preferred way to provide care for seniors recovering from illness or injury. It allows seniors to heal in the comfort of their own homes rather than in a hospital or facility-based setting, thereby improving quality of life and reducing Medicare costs.

We urge lawmakers in Congress – while they still have time in the final weeks of this legislative session – to support home health payment reform legislation so we can make sure reforms are designed and implemented in a way that puts patient need at the center of decision making. This is more than just good policy, it’s the right thing to do for disabled and senior Americans.

Keith Myers is Chairman of the Partnership for Quality Home Healthcare. William A. Dombi, Esq. is President of the National Association for Home Care & Hospice.