Home Health & Hospice Week

Home health agencies aren't going to have an easy time fighting off a copayment proposal this legislative session, and a new list of cost-cutting suggestions from an influential advisory body to Congress won't help.

In its September meeting, the Medicare Payment Advisory Commission proposed a set of draft recommendations with a host of HHA and hospice items. The list includes recommendations MedPAC has made in previous reports to Congress (Tier I) and new suggestions (Tier II). The proposals aim to offset a fix to the physician sustainable growth rate reimbursement problem.

One of the biggest money-generators in the Tier I list is an HHA copay, which MedPAC last year tentatively suggested be set at $150 for episodes with no preceding hospital stay. Such a copay would strip $2 billion from Medicare spending over the next five years and $4 billion in the next decade.

Acopay "would impose a 'sick tax' on some of the oldest, poorest and sickest Medicare beneficiaries; threaten access to vital home health care services; and result in an increase in more costly institutional care," protests the National Association for Home Care & Hospice. Plus, "home health took $39 billion in payment cuts in the Affordable Care Act and is facing an additional 5 percent cut if CMS's proposed case mix reduction is implemented."

Ahome health copay "is a short-sighted proposal that will harm beneficiary access to care and shift costs to vulnerable Americans," agrees the Visiting Nurse Associations of America.

MedPAC's recommendation dovetails with a recent proposal from President Obama to institute a $100 per episode home health copay (see Eli's HCW, Vol. XX, No. 34, p. 266).

In addition to the copay: MedPAC's other Tier I suggestions include cutting any inflation update for HHAs in 2012 and moving home health prospective payment system rebasing up from 2014 to 2013. Those two moves would cut $10 billion from Medicare home health spending over 10 years.

In the Tier II category, MedPAC suggests applying "readmission policies" to post-acute providers including HHAs. The move would cut $4 billion from Medicare spending over a decade.

Often, the hospice industry gets a bye in budget-cutting negotiations. But this year, hospices' rising for-profit profile and growth have landed them in policymakers' crosshairs.

In the Tier I category, MedPAC suggests a hospice payment update of only 1 percent in 2012 (which takes effect Oct. 1).

In the Tier II category, MedPAC recommends reducing hospice rates in nursing homes by 6 percent. That suggestion is based on a recent HHS Office of Inspector General report about "highpercentage hospices" who serve many patients in nursing homes (see Eli's HCW, Vol. XX, No. 30, p. 233). The OIG report recommends reducing Medicare payment rates for hospice patients residing in nursing facilities.

MedPAC's suggestion would strip $3 billion from Medicare hospice spending over 10 years, the commission estimates.

Hospice payment updates should remain intact given the "low financial margins across the sector, the ongoing phase-out of the BNAF, and current efforts to refine the payment system," NAHC contends.

Plus, study data suggests "some hospices are actually losing money on care provided to nursing home residents," the trade group argues. "This change would most harm providers that are least able to absorb such losses."