Home Health & Hospice Week

CJR already squeezing home health.

Many home health agencies breathed a sigh of relief when the Centers for Medicare & Medicaid Services limited or eliminated altogether bundling models that were expected to limit home health utilization and payments.

In a proposed rule released Aug. 15, CMS says it wants to pare the geographic areas subject to the Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. “In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis,” the agency says in a release. “In this rule, CMS also proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas.”

CMS proposes to cancel altogether the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, which were scheduled to begin in January 2018.

At one time, Florida HHAs were braced to get hit with both CJR (which CMS said wouldn’t affect HHA payments) and Pre-Claim Review at the same time. Now, under the Trump Administration, both of those projects are shelved, or at least scaled back for CJR.

“Moving forward, CMS expects to increase opportunities for providers to participate in voluntary initiatives rather than large mandatory episode payment model efforts,” CMS says in the release. “The changes in the proposed rule would allow the agency to engage providers in future voluntary efforts, including additional voluntary episode based payment models.”

The bundling initiative has caused hospitals to try to control costs by pressuring physicians to limit the amount of home care ordered, says the National Association for Home Care & Hospice. “NAHC has heard that only four physical therapy visits are routinely being ordered, regardless of patient circumstances or needs,” the trade group says in its member newsletter. “No nursing or home care aides are being ordered.”

The result is a Low Utilization Payment Adjustment (LUPA) payment to HHAs rather than a full episodic payment, and lower home health quality measure scores, “since the patients are not allowed to receive enough service to attain the desired health goals,” NAHC criticizes.

CMS expects around 470 hospitals to still participate in the CJR bundling program, NAHC notes.