Home Health & Hospice Week

Commenters: The doors of the most-needed HHAs will close under the new payment system.

Many home care providers used facts and logic to argue against the steep behavioral adjustment reduction coming under PDGM. But others took a more heated approach to try to get through to Medicare officials.

The Patient-Driven Grouping Model proposed rule “quite frankly leave[s] us in fear of the future of home care,” says All Coast Therapy Services Inc. in Florida, in its comment letter on the 2020 home health payment proposed rule. “The regulation changes with the complete overhaul of the Conditions of Participation has had an extreme labor and financial burden on the agency.”

“We have sadly over the past few years seen agencies of our size disappear into the abyss and lose the battle due to not being able to financially sustain the cuts and regulatory changes,” All Coast Therapy continues. “Every year we have had to endure significant increases in cost because of regulatory changes while our reimbursement from Medicare has been cut. Further cuts like these will only lead to less choice, increased need for institutionalization, decline in quality of care with resulting increase in Medicare cost.”

The preemptive nature of 2020’s cut drew much criticism. “The proposal to prematurely punish agencies for ‘behaviors’ not yet exhibited is ludicrous,” blasts 22-year nursing veteran Sharon Tatum in her comment letter. “I would liken that to executing a person because it is believed he may one day commit a heinous crime.

“What you (collectively) do not seem to realize is that throwing hundreds of pages of regulations at the fraudulent companies does not stop them; it merely makes their masterminds work harder to overcome your rules,” Tatum continues. “Meanwhile the little guys, such as my non-profit, small town agency, cannot afford to hire the volume of staff and a legal ‘dream team’ of lawyers and businessmen to counteract the damage done by the massive regulatory burden and reimbursement slashes you levy on home health agencies.

“Instead of punishing all agencies for the actions of some, why don’t you increase your hands-on, in-person oversight of agencies, and stop throwing reams of paper full of regulations at them that serve only to restrict the elderly and disabled citizens’ access to care?” Tatum challenges.

PDGM as proposed threatens access, numerous commenters tell CMS. “As the industry prepares for the ‘Silver Tsunami’ of Baby Boomers utilizing more health care resources than ever before, the absolute last thing we need is Home Health Agencies going out of business based on incorrect assumptions,” maintains Pamela Bennett in her comment letter. “Pair that with an acknowledged shortage of primary care physicians, and the question becomes just who does CMS think will be able to provide care to this population?” she asks.

“Patients will not receive adequate and timely post-acute care interventions, re-hospitalization rates will increase, and CMS will ultimately end up paying more for poorer quality care,” Bennett warns. “In general, there is no appropriate reason to penalize an entire industry because CMS is unable to control the actions of a very small number of bad actors.”

Melissa Morton-Jost in Illinois gives voice to many providers’ sentiments in saying “I find it insulting that CMS believes that we would manipulate our documentation in order to take more of the Medicare beneficiaries’ dollars to care for them than is actually needed,” according to her letter.

Many commenters cited how low agencies’ resources are to tackle PDGM, thanks to years of onerous regulations. “I have been in the home care field for 20 years now and seen the continuous attack that this industry has received via over burdensome regulations, slashing of reimbursements, unfair targeting of providers and many other procedures/regulation that have put many quality providers out of business and threaten many others,” says Tim Beach with Doctors Choice Home Care Inc. in Sarasota, Florida. “Year after year we endure the cuts despite rising cost of operations, including the cost of managing the many new regulatory processes implemented by CMS, reimbursement continues to decrease and at times [is] slashed specifically as this proposed rule plans to do. This is not a straw, but rather the log, that will break the camel’s back and will hurt access to care for Medicare patients,” Beach insists in his comment letter.

“Please reconsider the Behavioral Adjustment of 8.01 percent and give small honest providers like myself a fighting chance to adapt,” Beach implores.

“We have already been forced to limit where we can accept patients because of continued Medicare payment cuts through sequestration, reduction in diagnosis that determine a portion of our payment and overall decreased average episodic payments,” says Sandy Keltner in her letter. Keltner says she works with a freestanding, independent agency that services a large rural area.

“Many agencies will not be able to sustain with this financial impact,” Keltner warns CMS. “With the continued payment cuts and continued increase in more documents required, I fear agencies will be closing their doors.”

Nonprofit Pioneer Home Health Care Inc., a small, rural agency in the frontier area of California’s Eastern Sierra, is “the sole provider of home health in this vast area, nearly the size of Maryland,” explains Pioneer Administrator Pat West in her comment letter. “For those of us who have no margins, this can well represent our demise. Should we cease to exist because of the arbitrary plan, the Eastern Sierra community will no longer have access to home health care.”

One agency asks CMS to consider the personal cost of PDGM. “You could be in need of home health care in the future or your family members, and my hope is that you find a caring, compliant, quality agency,” says one Florida commenter. “With these changes, your chances will be slim.”