Home Health Legislation Could Strengthen Payment Reforms, Protect Patients

Quality health care in the United States today is largely guided by evidence-based practice — meaning that providers make conscientious treatment decisions for their patients based on proven, scientifically grounded evidence that has been shown to be effective.

They don’t simply guess or make assumptions when it comes to care that could significantly affect someone’s life or health. They rely on data, evidence and facts.

When it comes to critical policy decisions, shouldn’t our nation’s policymakers do the same?

This fall, home health providers certainly hope that members of Congress will pass health care payment reform legislation that indeed does depend on facts. It’s important because, as it currently stands, a recently finalized home health payment model — the Patient-Driven Groupings Model — allows arbitrary rate reductions for home health providers based on assumptions — not actual behavior. If unaddressed by Congress, the PDGM stands to destabilize the home health care sector for the more than 3 million American seniors with Medicare who depend on the benefit annually.

Unfortunately, we already know from past experience that assumption-based rate reductions could lead to a drop in the use of home health services. And seniors need access to these services now more than ever before because of the rising tide of American seniors and an increased focus on ensuring patients receive care in the most clinically appropriate, lowest-cost setting — the home.

Absent a legislative solution, under the PDGM, the home health sector will be hit with Medicare reimbursement rate cuts of an estimated 6.42 percent — equaling more than $1 billion annually — starting in 2020.

American seniors rely on home health care in order to recover from injury, surgery and illness at home without requiring additional trips to the hospital. With the help of more than half a million skilled, professional caregivers, these homebound seniors receive safe and effective medical care that was once offered only in a hospital or a clinical setting. Data show that skilled home health care can be less expensive, but just as clinically effective, as care provided in an inpatient health care facility.

Our elderly, homebound patients can’t afford cuts that threaten their care — particularly when the Centers for Medicare and Medicaid Services hasn’t provided any rationale for them.

Rather than enacting changes to reimbursement based on assumptions under the PDGM, it’s critical that our policymakers follow the facts and act upon evidence.

Fortunately, three separate pieces of legislation will ensure precisely that. S. 3545, S. 3458 and H.R. 6932 would amend several provisions of the Balanced Budget Act under which the PDGM was created — requiring Medicare to implement adjustments to reimbursement rates only after behavioral changes by home health agencies related to the new payment model that affect Medicare spending actually occur, instead of assuming changes might happen.

Additionally, S. 3545 includes a provision strongly supported by the home health community to permit the waiving of the homebound regulatory requirement to enable greater flexibility for Medicare beneficiaries in Medicare Advantage plans (and waiver programs) to receive home health services.

By requiring the new payment model to utilize observed evidence of behavioral changes, the bills would ensure a smoother transition to the new payment system — the most significant payment change to the home health system in more than 20 years — and, most importantly, protect patient access to continuity of care. They would also ensure Medicare budget neutrality but require the phase-in of any necessary rate increases or decreases to be no greater than 2 percent per year in order to limit the risk of disruptions in care.

Just as evidence and facts guide effective treatment, so should they guide smart policy. It’s the common-sense and wisest approach — and one that puts the needs of American seniors at the forefront.


Tim Rogers is the chairman of the Council of State Home Care and Hospice Associations.

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