Home Health & Hospice Week

President Obama issued a report to the socalled "super committee" tasked with finding more than a trillion dollars in budget savings by Thanksgiving. In the report, the president proposes a home health agency copayment of $100 per episode, starting for new beneficiaries in 2017. The copay would apply only to non-LUPA episodes not preceded by an acute inpatient stay.

The report cites the Medicare Payment Advisory Commission's similar recommendation in its last congressional report (see Eli's HCW, Vol. XX, No. 11, p. 84). MedPAC suggested a $150 copay amount, however.

The copay would strip $400 million from Medicare spending over 10 years, the report says.

The industry has come out swinging against the proposal. The Visiting Nurse Associations of America "is deeply disappointed that the Administration has decided to ask vulnerable seniors to pay more for home health services that provide essential care to seniors and the disabled, and keep people in their homes and out of more expensive institutions," the trade group says in a release. The proposal "would shift costs from the Medicare program to vulnerable seniors, many of whom have incomes below $30,000 per year, suffer from multiple chronic conditions, and are over the age of 75."

The National Association for Home Care & Hospice "strongly opposes the President's proposed home health copayment and believes deficit reduction should not come in the form of a 'sick tax' on the nation's poorest and sickest Medicare beneficiaries," the trade group tells its members. "Also, more payment cuts would mean more agencies for which Medicare pays less than costs, putting access to care at risk."

Short-sighted: "Even a minimal copay will lead patients to skip much-needed home health assistance, causing them to end up back in the hospital or another institutional setting at a much greater costs to themselves and to the Medicare program," VNAA maintains. "Now is not the time to create barriers to access to home health, which is more cost-effective than alternative care settings."

The President's proposal is far from the last word on the matter, however. The congressional committees of jurisdiction in the House and Senate will be submitting their own proposals to the super committee next month, NAHC notes. Then the super committee will be making its own choices.

Home care already has some allies in Congress. "I am strongly opposed to the idea of significant new copays for Medicare home health care patients. I cannot support balancing the budget on the backs of the sickest and frailest," Rep. Jim McGovern (D-Mass.) tells NAHC. "Slapping seniors with high co-pays not only discourages care -- it makes it more likely that seniors will be forced into more expensive nursing home care. There are smart ways to control health care costs. Taxing sick and frail seniors is not one of them."

And the industry has some heavy-hitting lobbyists as allies, including the AARP. "AARP reiterates its strong opposition to any proposals that would raise costs or cut the hard earned Medicare benefits that millions of seniors depend upon every day ," says AARP's Nancy LeaMond. "Elected leaders can make responsible decisions that do not hurt seniors, raise their out of pocket costs or cut the benefits they have earned over a lifetime of hard work."

Home care industry members across the nation are already getting the word out about the harmful proposal. For example, a San Angelo, Texas home care nurse wrote a letter to the San Angelo Times decrying the cuts. "Copayments and additional payment cuts would be devastating to access to care for home health care patients," RN Breta Easterwood says in the letter published in the newspaper. "Copayments are an inefficient and regressive 'sick tax' that would fall most heavily on the oldest, sickest and poorest Medicare beneficiaries."

Plus: The president's proposal also suggests that the Centers for Medicare & Medicaid Services "adjust payment updates for certain post-acute care providers." That almost certainly would apply to home care providers, which show relatively high average profit margins, experts believe.

Hospice cuts are probably excluded from this vague category, NAHC expects.