Home Health & Hospice Week

Influential advisory body continues its pressure to implement a home health copay.

Your uphill battle to reverse home health agency rebasing cuts under Medicare just got steeper.

As indicated in earlier meetings, the Medi-care Payment Advisory Commission finalized its recommendations to cut HHA payment rates in its Jan. 16 meeting. It its March report to Congress for 2015, MedPAC will reiterate its recommendations from last year, including cutting agencies’ inflation update to zero; implementing a copayment for home health episodes not preceded by a hospital stay; speeding up the timeline for rebasing cuts (currently set at a 14 percent reduction over four years); and minimizing therapy’s impact on the home health case mix calculation.

MedPAC’s recommendation on a copay is "the least sensible copay concept in that it would encourage patients to seek high cost hospital care to avoid home health copay," protests the National Association for Home Care & Hospice. "Instead, Medicare should encourage early use of home health services to avoid both initial hospitalizations and readmissions."

New recommendation: MedPAC commissioners also approved a new measure to reduce payment amounts for HHAs with high hospital readmission rates. The Centers for Medicare & Medicaid Services would use its discretion to set the threshold level under the proposal. Nearly one-third of home health patients saw such readmissions in 2010, according to MedPAC.

Commissioners were worried about the provision’s side effects, though. HHAs may not want to admit patients who were at high risk of readmissions, for example.

"A value-based reimbursement system requires a reliable risk adjuster and a precise standard for determining ‘avoidable’ rehospitalizations to operate fairly," NAHC says. The trade group would also like to see bonuses for low readmission rates added to the payment system.

Another new recommendation: MedPAC wants Congress to require a new assessment tool for all post acute care (PAC) settings.

Warning: "With the flurry of activity on the physician SGR legislation expected this year, the recommendations are likely to take on a special weight in Congress’ search for ways to pay for the physician rate reform," NAHC cautions.

Hospices Get Cold Shoulder From MedPAC

MedPAC also voted to keep hospices’ payment rates flat in 2015. "Hospices are reeling from a growing number of costly new regulatory obligations, and they fear the impact of an impending payment system overhaul," says NAHC’s Val Hala-mandaris in a statement. "These proposed changes will have a negative impact on the integrity of the Medicare hospice benefit and access to it."

And MedPAC wants hospice wrapped into the Medicare Advantage payment umbrella. "We worry that this change will seriously limit the most important health care provider choice of a beneficiary’s life," Halamandaris says.