Home Health & Hospice Week

HH leaders ‘strained to the breaking point,’ one industry veteran warns Medicare.

Nursing homes and hospitals saw big financial help from Medicare when they were slammed by the COVID-19 Public Health Emergency — where was similar help for home health agencies? That’s what multiple commenters on the 2022 home health proposed rule are asking the Centers for Medicare & Medicaid Services in their comment letters.

“While hospitals and SNFs saw significant adjustments made in payment models and payment amounts, HHAs have not,” says Lora Mayes with Beacon Home Health Agency in Stafford, Texas, in her comment letter. “Instead, the COVID-19 patients have had to be fit into a payment model that had no such comparable patients in its foundational database,” Mayes says.

“While the costs of care rose generally for the entire patient population served by HHAs through such continuing cost increases as labor and PPE, the 2021 reimbursement rates did not change,” the Texas Association for Home Care and Hospice’s Rachel Hammon highlights in the trade group’s letter. “If CMS had included a process for mid-year adjustments for unexpected cost increases, stabilization of home health care access would be more readily achievable,” she says.

“The impact that the COVID pandemic has had on home health is one that we hope will eventually end, but currently the end is not in sight,” warns Cheryl Foster with North Kansas City Hospital Home Health in her comment letter. “Home health agencies have faced challenges of providing care for sicker patients due to hospitals not having beds available and nursing homes not accepting new patients. In addition, we are providing care for seriously ill COVID patients and dealing with increased needs for personal protective equipment, all of which have placed a major strain on both the financial status of the agencies and the well-being of our workforce,” Foster tells CMS.

“While hospitals and nursing homes saw adjustments made in their payment models, home health agencies did not. We were expected to provide increased services to sicker patients under the same payment model that had been established prior to the pandemic, creating greater financial losses for the agencies caring for these patients,” Foster says.

“I have been working in the home health industry for 28 years, and home health has seen more major changes in the past two years than in my entire career previously,” Foster emphasizes “Home health leaders are strained to the breaking point, and many are retiring early rather than facing more change. We all know that change is inevitable, but in the midst of an ongoing [PHE ... the impact of the pandemic needs to be taken into account rather than ignoring it and making changes as though agencies have not been dealing with abnormal situations in the past year,” Foster exhorts.

Many commenters are telling CMS similar stories of incredible pressure. “The current COVID-19 pandemic has been a true test of VNA Health Group’s resolve to continue to fulfill its mission,” the New Jersey-based provider says in its comment letter. “Despite significant risk to their own health and safety,” VNAHG’s staff “stepped up (and continue) to serve acutely ill COVID-19 patients of all demographics to help offload hospitals and emergency rooms during surge periods. As many of our own staff took ill from the SARS CoV-2 virus, their coworkers worked longer hours and assumed extra shifts to ensure that vulnerable, at-risk patients got the care they needed.”

Now: Considering the surge, “the challenges of the pandemic are far from over in our communities,” VNAHG says.