Home Health & Hospice Week

Copay out, rate cut in at press time.

Getting rid of the persistent need for “doc fix” legislation may get home health agencies out of the budget hot seat in the long run, but it won’t be worth it if too much of the funding comes out of HHAs’ wallets now.

At press time, lawmakers were working across party lines to secure passage of legislation that would eliminate the sustainable growth rate (SGR) formula for Medicare physician payment once and for all. Physicians will face a 21 percent cut to reimbursement rates April 1 if no doc fix is passed. Congress has passed 14 SGR “patches” over the years.

Eliminating SGR would be welcome by all Medicare providers, because when it’s time to avert the steep cuts to docs’ pay that the SGR requires, the funding often comes out of other provider types’ reimbursement. However, the price of saying goodbye to doc fixes may be too steep for HHAs.

The swiftly emerging deal appeared fluid, but the National Association for Home Care & Hospice reported that a copayment was not part of the package. Reductions to payment updates for HHAs and hospices, however, were included at that time.

Beware: HHAs provide a juicy target for lawmakers looking for a funding source, due to their relatively high Medicare profit margins and utilization growth (see statistics, p. 83). And inclusion of a copayment as a “pay-for” is a popular, recurring idea with lawmakers, points out attorney Robert Markette Jr. with Hall Render in Indianapolis.

Watch for: Stay tuned to see whether a permanent SGR elimination is passed, and if so, how it will impact you.