Home Health & Hospice Week

The health care reform package passed by the House and Senate and on the way to becoming law contains bad news for home care providers -- but some silver linings too.

Lawmakers turned in part to Medicare spending to fund the health care system changes. The legislation will cut about $39 billion over 10 years from Medicare home health agency spending, notes the National Association for Home Care & Hospice. The cuts include rebasing of prospective payment system rates phased in starting in 2014, a home health "productivity adjustment" cut in 2015, and inflation update reductions starting next year.

The Visiting Nurse Associations of America has "deep reservations ... about the level of cuts Medicare home health and hospice providers will experience and the impact on the communities and patients they serve," VNAA says in a release.

At least the cuts were not as severe as those originally entertained by the House, NAHC says. Legislation passed there called for $57 billion in HHA payment cuts.

A plus: And the reform package will reinstate a rural add-on for HHAs, although it will be only 3 percent, NAHC adds.

The bill also starts a health care system reorganization that will place more emphasis on preventive care and will value care coordination. That could put home care providers "in the center of the action," says NAHC's Val Halamandaris.

The legislation bolsters community-based care and cracks down on Medicare fraud and abuse issues that have plagued the industry, VNAA praises The trade groups pledge to support the positive changes and work to mitigate the rate reductions, they say.

Hospice Cuts Loom Hospices will see inflation and productivity cuts starting in 2013, notes the National Hospice and Palliative Care Organization. The cuts will strip $7.8 billion from Medicare hospice spending.

That's too much on top of the budget neutrality adjustment factor (BNAF) wage index cuts hospices already are undergoing through 2016,NHPCO protests.

Other provisions affecting hospices include an unspecified payment reform mandate, an option to test value-based purchasing (i.e., P4P), and a demonstration program to pilot hospice patients receiving curative Medicare services, NHPCO notes.

Wheelchair Change Hits DME Durable medical equipment suppliers also see some strong negatives in the package. The legislation eliminates the first month purchase option for all but complex rehab power wheelchairs, notes the American Association for Homecare. That will result in ill-fitting wheelchairs that can lead to pain, skin sores, and loss of mobility for beneficiaries.

"Power wheelchairs -- unlike most standard wheelchairs, intended for temporary use -- are often prescribed to those with lifelong medical needs and therefore require a high degree of  customization to ensure the individual's quality of life, mobility, and independence," the trade group says in a release. "Nearly all beneficiaries elect the purchase option because they live with long-term, debilitating conditions that require customized equipment to meet their specific life-long needs."

The bill will also require face-to-face visits with doctors before the docs order DME for patients, points out the National Association for Independent Medical Equipment Suppliers. And it calls for unspecified productivity "adjustments." More changes for DME are expansion of competitive bidding and pharmacy accreditation exemptions.

All providers will be affected by beefed up program integrity provisions, including stepped up recoveries, enhanced enrollment procedures, and Recovery Audit Contractor program expansion.

And all providers could fall subject to Medicare rate-cutting recommendations made by the newly created Independent Payment Advisory Board. IPAB has been deemed "Super-MedPAC" by some industry proponents.