Home Health & Hospice Week

VBP agencies are still included.

While the Comprehensive Care for Joint Replacement (CJR) model isn’t on some home health agencies’ radar, others took the opportunity to weigh in on Medicare’s proposed rule.  However, they mostly came away empty-handed.

Here are two of the most popular topics home care providers and their reps commented on during CJR rulemaking:

• VBP. Some of the CJR areas overlapped with areas proposed, at the time, for Home Health Value-Based Purchasing. “How can Medicare try 2 new ideas to limit payments to home health at the same time?” asked a rep from Community Therapy Home Care Inc. in Florida, in its comment letter on the CJR proposed rule. “If your point is to put us out of business and have less health care for the American public, it is a great idea. This is not fair to those of us that would be faced with both of these rules and for all other states to keep the old ways andpayments.”

Publicly traded chain Almost Family Inc. pointed out in its comment letter that “18 out of 75 (24%) Joint program MSA’s overlap with the HHVBP states.”

HHAs aren’t the only losers in imposing the double-demos, said a Director of Nursing for a Boca Raton, Fla., agency in her comment letter. “Forcing HHAs to have to participate in both demonstrations simultaneously … would quite likely skew the results of both demonstrations in those areas of overlap,” she told CMS.

“Providers should only have to participate in one demonstration at a time to give adequate focus and accurate data,” Florida’s Alison Stickney said in her comment letter.

Result: CMS shot down the multiple requests to exclude VBP areas from CJR or vice versa. “Only participant hospitals under the CJR model are financially responsible to CMS for the episode of care,” CMS says in the CJR final rule.

“HHAs will continue to be paid the FFS amount that they would otherwise receive for beneficiaries included in the CJR model. Therefore, there is no reason to exempt hospitals located in MSAs selected for participation in CJR that are also located in states selected for participation in the HHVBP model.”

• Patient choice. HHAs are very concerned that CJR will lead to prohibited patient steering. While CMS specified that patients must retain their ability to choose PAC providers in the proposed rule, hospitals already have other ideas.

“CMS might consider strengthening the requirements for discharge planning to ensure all post-discharge support options are explained to beneficiaries and an effective, patient-centered discharge plan is developed,” recommends the Texas Association for Home Care & Hospice in its comment letter.

Hospital take: “While we support beneficiary choice, we would like CCJR to allow hospitals to focus their post-acute collaborative efforts to a discrete set of partners in the community, given that hospitals are at financial risk,” said Providence Health & Services, a health system based in Washington state, in its comment letter on the proposed rule. “Providence encourages CMS to provide waivers to CCJR participant hospitals that would allow for collaborations with certain SNF and home health agencies, like agreements anticipated in the Next Generation ACO model. CMS could require that hospitals have formal collaboration agreements with more than one of each potential referral type so beneficiaries continue to have choices and there is sufficient access to services, while the hospital is able to better manage costs and care pathways.”

Result: On one hand, CMS promises to “modify the beneficiary notice requirements as recommended in comments, to require participant hospitals to — (1) Inform the patient or the patient’s family of their freedom to choose among participating Medicare providers/suppliers of post-hospital care services; (2) respect patient and family preferences when they are expressed; and (3) present a complete list of qualified providers/suppliers that are available to the patient.” CMS adds, “We believe that these requirements were inherent in our proposal to require notice of all qualified providers/suppliers but we acknowledge that the additional details may be helpful.”

On the other hand: “Hospitals, if desired, may recommend ‘preferred providers,’ that is, high quality PAC providers/suppliers with whom they have relationships (either financial and/or clinical) for the purpose of improving quality, efficiency, or continuity of care,” CMS specifies in the final rule. Hospitals do have to disclose such financial relationships in their patient notices, the agency says.

Keep in mind: If a hospital specifies an HHA as a preferred provider, that’s usually who the patient will go with, says attorney Robert Markette Jr. with Hall Render in Indianapolis. Especially if the patient has no home health experience prior to the knee or hip replacement.