Home Health & Hospice Week

Pittsburgh-based managed care organization Highmark recently cut eight home health agencies out of its commercial and Medicare Advantage networks for 2016, reports the Pittsburgh Post-Gazette.

“I’ve probably been 30 years with Highmark,” said Connie Slampak, administrator for Abby Home Health Services in Uniontown, Pa., one of the HHAs dropped, reports the newspaper. The Blue Cross Blue Shield affiliate first notified Abby last fall of a 21 percent pay cut. “I believe they were hoping I would not sign the contract.” But Slampak did sign, only to get another notice in December that Highmark was dropping Abby.

“This was totally unforeseen,” she told the Post-Gazette. “To have my contract cut for no reason is kind of demeaning.”

Administrator Roselle Tena at Renaissance Home Care in Mt. Lebanon had diversified service lines in anticipation of potentially being dropped, she said. But losing Highmark “is an extreme impact.” She suspects her client list of nearly 100 wasn’t enough volume for Highmark, despite high patient satisfaction scores.

“It’s showing the way that home care is moving with this value-based purchasing,” she said. “The problem I have is I don’t know how the really frail, the really vulnerable, are going to access care.” A Highmark rep told the newspaper that it is using data such as Home Health Compare to make decisions. But the dropped providers complain they were given no explanations for why they were cut, according to the newspaper.

Takeaway: This case shows “the lack of control that a hospice provider may have in payment negotiations and inclusion in such Plans, even though they continue to meet all hospice conditions of participation in the Medicare program,” notes The Health Group in Morgantown, W. Va. Highmark also cut 10 nursing facilities from its networks.