Home Health & Hospice Week

Bad: If the committee can't come to an agreement, 2 percent across-the-board cuts for all Medicare providers are scheduled to kick in for 2012. That would be on top of the 2.3 percent cut already slated to take place Jan. 1.

Worse? But if the congressional super committee does come to an agreement, it's very likely to include cuts for Medicare home care reimbursement anyway. And those cuts may be more damaging to your bottom line than the flat 2 percent reduction, observers worry.

Chief among the suspected provisions is one for a home health agency copayment. Everyone from the Obama administration to the Medicare Payment Advisory Commission has recommended it.

The Kaiser Family Foundation expects a 20 percent copay would reduce Medicare's home care spending by $3.6 billion in 2013 alone, it says in a new report. The decrease would be due to a combination of the beneficiary cost sharing and the reduced utilization that such cost sharing would cause.

But the home care industry continues to fight against such copays. "Congress ended home health copayments in 1972 for a good reason," Visiting Nurse Associations of America CEO Andy Carter says in a release. "They led to less use of cost-effective home healthcare and more use of expensive hospital and nursing home care."

"Copayments are especially dangerous for lower income seniors for whom even a relatively small copayment can lead them to forgo essential home-based healthcare services and then end up back in the hospital," Carter notes.

"Copayments are an inefficient and regressive 'sick tax' that would fall most heavily on the oldest, sickest, and poorest Medicare beneficiaries," the National Association for Home Care & Hospice says in an issue brief on the topic.

Instead of imposing a copay or more rate reductions, VNAA recommends imposing a moratorium on new HHA entrants, placing "controls" on the number of recertifications per patient, and requiring all agencies to treat LUPA patients.

HHAs should lobby their elected representatives to oppose both a copay and any across-theboard cuts, NAHC urges.

Resource: The KFF's report analyzing deficit reduction proposals is at www.kff.org/medicare/upload/8256.pdf.