Home Health & Hospice Week

‘For-profit’ seems to be a dirty word to MedPAC.

Lawmakers will be checking out the data the Medicare Payment Advisory Commission served up in its March report to Congress, when making decisions on whether to block the preemptive behavioral adjustment rate cut for the Patient-Driven Groupings Model and other legislative matters.

Take a look at what MedPAC told your elected representatives about 2017 data:

• The number of HHAs fell by 3 percent to 11,844 compared to 2016, “but this decline follows a long period of growth in prior years,” MedPAC said. From 2004 to 2016, the number of HHAs increased by 60 percent. “The decline in 2017 was concentrated in areas that experienced sharp increases in supply in prior years,” according to the March report. MedPAC also pointed out that the 2017 number is “higher than the level of supply during the 1990s” and that “almost all the new agencies since implementation of the PPS have been for-profit providers.”
• Home health spending dropped by 2 percent, from $18.1 billion in 2016 to $17.7 billion in 2017. However, between 2002 and 2016, spending increased by more than 88 percent.
• Home health users dropped by 1.7 percent to 3.4 million.
• The number of episodes declined by 3.1 percent to 6.3 million. But five states — Florida, Illinois, Louisiana, Tennessee, and Texas — accounted for “most of the decline in episodes,” MedPAC insisted. And “utilization in these five states had more than doubled between 2002 and 2011, higher than in most other areas.”
• Five states saw a 25 percent decrease in episodes while “44 states experienced aggregate growth of 4.1 percent, though there was a range of increases and declines across these states,” the report said. “The volume decrease in areas that have been targeted by program integrity efforts suggests that these efforts can address excessive or unwarranted services, and the expansion of these efforts to other areas with excessive growth rates would be beneficial.”
• The number of home health agencies per 10,000 FFS beneficiaries fell by 2.9 percent to 3.1. But “from 2004 to 2017, the number of HHAs per 10,000 FFS beneficiaries rose 46.6 percent,” the report noted. “Most of the new HHAs were for profit.”
• The number of visits dropped by 3 percent to 104.8 million. Aide visits dropped the most between 2016 and 2017, at 11 percent.
• Visits per user dropped 2 percent to 31.
• The ratio of FFS beneficiaries who used home health services dropped 1 percent to 8.8 percent.
• Episodes not preceded by a hospitalization accounted for most of the growth since 2002, increasing from about half of episodes in 2002 to two-thirds of episodes in 2017.
• Medicare profit margins for freestanding agencies averaged 15.2 percent. The projected margin for 2019 is 16 percent.
• Episodes per user fell 1.4 percent to 1.9. But between 2002 and 2016, the average number of episodes per user increased by 16 percent. The increased share of community referrals accounts for some of the drop, MedPAC maintained.
• More than 98 percent of beneficiaries lived in a ZIP code where an HHA operated in 2017, and 84 percent lived in a ZIP code with five or more HHAs.