Home Health & Hospice Week

Former MedPAC commissioner cites agencies’ high profit margins.

Home health agencies have been making a lot of noise to push back on the proposed rate cuts for 2024, and a Senate hearing has added a volume boost.

Background: HHAs and their representatives had reactions ranging from dismay to shock to fury when the Centers for Medicare & Medicaid Services proposed another significant cut for next year, this time to the tune of 2.2 percent (see HHHW by AAPC, Vol. XXXII, No. 24-25). Many providers have mobilized against the proposal with actions such as contacting their members of Congress and writing letters commenting on the rule.

On Sept. 19, the industry scored a win with a hearing, “Aging in Place: The Vital Role of Home Health in Access to Care,” held by the U.S. Senate Finance Committee’s Subcommittee on Health Care.

In the hearing, senators including Subcommittee Chair Ben Cardin (D-Md.) and Ranking Member Steve Daines (R-Mont.) heard mostly from witnesses who called for better reimbursement for HHAs, such as the National Association for Home Care & Hospice’s William Dombi and Carrie Edwards, director of home care services at Mary Lanning Healthcare in Hastings, Nebraska.

They reiterated many points HHAs have made in their comment letters (see related story, p. 262), and highlighted problems such as high referral rejection rates. Mary Lanning has seen rates reach over 50 percent this year, Edwards said.

But not all comments were industry-positive. “If the Congress is going to address rural access through payment, I would recommend they do so through a rural payment add-on or some other targeted rural policy,” advised witness David Grabowski, a professor with the Department of Health Care Policy at Harvard Medical School. “They should not try to solve a potential rural access problem through an adjustment to the overall fee-for-service payment system, which is currently paying home health agencies well above costs,” said Grabowski, who was a MedPAC commissioner until his term expired in April this year.

Witness Tracy Mroz, an occupational therapist and associate professor with the Department of Rehabilitation Medicine at University of Washington in Seattle, seemed to support this point, noting that “not all rural home health agencies are facing resource constraints and struggling to remain operational to serve their communities. Many are profitable.”

In his testimony, Grabowski also cast doubt on agencies’ claims of widespread staff shortages, cautioned against changing the Patient-Driven Groupings Model because “it is too early to draw strong conclusions about how this policy has impacted access given it was introduced at the start of the pandemic,” and urged “increased auditing and oversight of the existing agency-reported OASIS data.”

Judith Stein with the Center for Medicare Advocacy gave senators examples of HHAs shirking their responsibility to care for patients with significant aide needs and said “older and disabled Medicare beneficiaries are constantly denied adequate or all necessary home health care. It has become more the norm than the exception,” according to her testimony.

Nevertheless, senators made multiple positive remarks about the industry. For example, Cardin noted that “you can tell by the number of members here and their participation that this is an area of great interest to this committee.” He also said senators “understand the importance of home health care.”

“If finalized, the cuts would absolutely decimate beneficiary access to the care seniors overwhelmingly prefer,” says Joanne Cunningham with the Partnership for Quality Home Healthcare. “We are pleased that Congress is paying attention to this critical issue and is taking steps to prevent the implementation of continued cuts,” Cunningham says in a release.

Note: A replay of the hearing and witness’ testimony documents are at www.finance.senate.gov/hearings/aging-in-place-the-vital-role-of-home-health-in-access-to-care.