Home Health & Hospice Week

‘Regular’ Medicare becoming a thing of the past.

If Medicare wants to reduce costs through lower hospital readmission rates, it had better figure out how to also increase access to home care. That’s what attendees of the National Association for Home Care & Hospice March on Washington told a top Centers for Medicare & Medicaid Services official who spoke at the conference.

CMS Deputy Administrator and Director of the Center for Medicare Sean Cavanaugh focused his presentation on CMS’s push toward alternative payment models. In 2011, Medicare had no payments dispersed through alternative payment models, while this year CMS has already tied 30 percent of Medicare payments to the models, Cavanaugh told a full room at the conference.

The goal: By 2018, CMS wants to tie 50 percent of payments to non-fee-for-service models, Cavanaugh noted. And that percentage will only go up from there.

“The CMS Innovation train is moving at full speed,” warned NAHC’s William Dombi in a separate session at the conference. The “lifespan” of Medicare fee for service “is in doubt,” Dombi judged.

Among the alternative payment models affecting HHAs are the home health Value-Based Purchasing pilot in nine states that began Jan. 1, and the Comprehensive Care for Joint Replacement (CJR) model for hospitals that began April 1.

In the 2016 HH PPS final rule, CMS had insisted that CJR didn’t affect agencies because it impacts hospital payments only. But there’s no doubt that CJR is going to have a major impact on HHAs, experts insist (see story, p. 107).

VBP and CJR are just the beginning for home care. “We’re creating more and more alternative payment models,” Cavanaugh stressed in his talk.

Problem: As more models like CJR proliferate, agencies’ concerns about other providers controlling their reimbursement grow. “We’re very sensitive to that,” Cavanaugh insisted, acknowledging the potential “imbalance of power.”

Let Us Help You, HHAs Say

Cavanaugh noted in the presentation that hospital readmission rates improved when Medicare began implementing alternative payment models, but now the rate is “plateauing.”

One reason is because the Medicare program puts up barriers to home care, when home care services would help bring down those rates and limit costs, said NAHC Board Chair Denise Schrader in the question-and-answer period after Cavanaugh’s talk. Eliminating the homebound requirement, among others, would free up HHAs to help curb high hospital costs, said Schrader with the Visiting Nurses Association of the Rockford Area in Rockford, Ill.

“We struggle with artificial regulatory barriers,” agreed Lisa Harvey-McPherson, VP for government relations with Eastern Maine Healthcare System in Waterville, Maine. The face-to-face requirement is a particular problem, Harvey-McPherson told Cavanaugh. CMS makes exceptions to other regulations for other provider types in its payment models, so it should consider doing so for the cost-saving home care benefit too, she urged.

CMS’s hands are often tied by fraud and abuse concerns, Cavanaugh noted in the Q&A session. F2F and homebound requirements are seen as important fraud-deterring factors.

Of course, those providers intent on fraud simply pay for or produce their own bogus documentation, industry veterans point out. Those types of requirements generally limit only those providers who are following the rules anyway.