Home Health & Hospice Week

‘Home health market ... to remain robust,’ CMS maintains.

Many commenters on the 2017 HH PPS proposed rule warned Medicare that continuing to ratchet down home health agency payment rates will result in reduced access to cost-saving home care services. But the Centers for Medicare & Medicaid Services doesn’t agree. The Medicare Payment

Advisory Commission “concluded that, as a result of the payment update offsets to the rebasing adjustments,

HHA margins were likely to remain high under the current rebasing policy and quality of care and beneficiary access to care were unlikely to be negatively affected,” the agency maintains in the 2017 final rule issued Oct. 31. MedPAC wants even further cuts, CMS points out.

The dropping number of agencies isn’t cause for alarm, CMS maintains. “In CY 2015 there were 2.9 HHAs per 10,000 FFS beneficiaries, which is still markedly higher than the 1.9 HHAs per 10,000 FFS beneficiaries before the implementation of the HH PPS methodology in 2001,” according to the rule. “Even if some HHAs were to exit the program due to possible payment concerns, the home health market would be expected to remain robust.”

CMS does agree “to continue to monitor for the effects of rebasing as data become available,” though.

The National Association for Home Care & Hospice “remains concerned for the erosion of home health care access caused by rate reductions,” the trade group says. “CMS’s analyses tends to aggregate the impact evaluation using averages and a host of assumptions.”

The Visiting Nurse Associations of America also questions CMS’s contention that access is not a problem. “While CMS maintains that home health margins are high compared to an unspecified standard, the experience of our members is that Medicare payment rates underpay and do not reflect the real costs of serving vulnerable patients and maintaining a qualified, trained workforce,” the trade group states. “VNAA is concerned that access barriers to home based care will emerge, as agencies shutter their doors.”

For many agencies facing an uncertain level of payment cuts in the coming year, this Oklahoma commenter’s opinion on the proposed cuts may reflect their own viewpoint: “I apologize to the few among you at CMS that truly care about our elders. I have berated you when you likely don’t have enough influence to change what is wrong. To the rest of you, it is time for you to retire/resign/quit or whatever. You have lost contact with your soul. You need to go do a job that does not impact the lives of other people.”