Home Health & Hospice Week

Comprehensive health care reform may be up in the air, but President Obama expects billions of dollars to be stripped from home health agency spending one way or another.

The president's 2011 budget proposal released Feb. 1 does not spell out specific Medicare cuts. But it does assume that health care reform such as the bills advanced by Congress in November and December will pass and the included cuts will take place, Obama administration officials are saying.

This is bad news for home care providers.The House bill set out $55 billion in home health agency cuts over 10 years while the Senate bill contained $40 billion, notes the National Association for Home Care & Hospice. The House bill also would cut $8 billion from hospice payments.

HHA spending accounts for 3.7 percent of Medicare outlays, while hospice spending is 2.4 percent, the Office of Management and Budget notes in the President's 2011 budget documents.

"We are deeply disappointed that the President's budget seems to assume cuts to home health that are deeper than the last budget," says the Visiting Nurse Associations of America's Andy Carter. Last year President Obama called for $37 billion in HHA cuts over 10 years (see Eli's HCW, Vol. XVIII, No. 10, p. 74).

"While we await details, all we can do now is continue fighting for a more moderate approach to these across the board cuts that threaten access to home health care, especially for vulnerable, lowincome, high-complexity patients served by nonprofit providers," Carter says.

Providers should keep tabs on the course of health care reform in Washington, NAHC advises.

HEAT Initiative Gathers Momentum

The president's budget is more specific, however, about increasing funding for fraud-fighting activities. The budget proposal calls for an additional $250 million to fund program integrity efforts. That would net $10 billion in savings over 10 years, the budget predicts.

Those efforts include an additional $40 million for the joint Health and Human Services and Department of Justice Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, the HHS Office of Inspector General says in a release.

Crackdown ahead: The budget shows "historic support for anti-fraud efforts that will save billions over 10 years," HHS Secretary Kathleen Sebelius says in a release. The proposal has "increased investments in programs that have a proven record of preventing fraud, reducing payment errors and returning funds to the trust funds."

"We're encouraged that the president's budget strengthens anti-fraud and abuse efforts in Medicare," Carter tells Eli. The Centers for Medicare & Medicaid Services needs additional resources to implement new program integrity activities, including ones the VNAA has proposed.

"The budget is a good step forward in recognizing that substantial program savings can be achieved through a targeted means rather than across-the-board cuts that harm legitimate home health care providers along with the bad actors," Carter says.

Other provisions: There are a number of other proposals in the budget that could affect home care providers, including "several demonstration projects testing care coordination and care transition strategies that hold so much promise for improving outcomes of care for older adults," Carter praises.

"Special emphasis will be placed on demonstrations that improve care coordination for beneficiaries with chronic conditions, that better integrate Medicare and Medicaid benefits, and that provide higher value for dollars spent," the HHS budget summary notes.

The demos could go a long way toward "reducing all the waste that goes with preventable hospitalizations and poor transitions between acuteand post-acute care," Carter predicts. And "the Budget includes $103 million for the Administration on Aging's Caregiver Initiative,"according to budget materials. The initiative is "an effort to expand help to families and seniors so that caregivers can better manage their multiple responsibilities and seniors can live in the community."

The president's budget contains no durable medical equipment-specific cuts, notes the American Association for Homecare.

"This takes the stress off DME in the short term while we wait and see what, if any, health care reform bills will be advanced," notes the National Association of Independent Medical Equipment Suppliers. But "the industry is still vulnerable to the many proposals in the House and Senate bills."

Not so fast: The focus on ramping up fraud and abuse prevention activities could be dangerous for legitimate suppliers, however. "We welcome a greater commitment to fraud prevention," AAHomecare says. "However, we remain concerned that Medicare and the Office of Inspector General confuse fraud with the errors that result from a confusing and complex Medicare claim-filing process."

The feds should focus their scrutiny on those who deserve it, the trade group says. They can use tactics like real-time claims monitoring and more frequent site visits to "help eliminate Medicare fraud while allowing legitimate providers to serve patients without undue regulatory burdens."