In The News

MEDPAC Recommends Substantial Reduction to Home Health Payments

The Health Group, LLC

MedPAC’s March 2023 Report to Congress included the following recommendation:

“Our review of payment adequacy for Medicare home health services indicates that access is more than adequate in most areas and that Medicare payments are substantially in excess of costs. Home health care can be a high-value benefit when it is appropriately and efficiently delivered. Medicare beneficiaries often prefer to receive care at home instead of in institutional settings, and home health care can be provided at lower costs than institutional care. However, Medicare’s payments for home health services are too high, and these excess payments diminish the service’s value as a substitute for more costly services. On the basis of these findings, the Commission recommends that, for calendar year 2024, the Congress should reduce the 2023 base rate by seven percent (7%)."

The recommendation is largely justified by MedPAC on the basis that in 2021 the average cost of a thirty (30) day episode of care decreased by 2.9%, Medicare’s payment per in-person visit increased by 17.6%, and the Medicare margin for freestanding agencies averaged 24.9%, a historical high.

MedPAC acknowledges that home health care can be provided at lower costs than institutional care; however, the excess payments diminish the service’s value as a substitute for more costly services.

Amazingly, the number of home health agencies continues to decline as follows:

  • · 2018                            11,699
  • · 2019                            11,569
  • · 2020                            11,556
  • · 2021                            11,474

Since 2013, the number of home health agencies has decreased by over 10%.  In fact, not only have the number of agencies declined, the number of Medicare fee-for-service (“FFS”) beneficiaries using home health services has declined as well.  MedPAC describes the reduction as follows:

“More Medicare beneficiaries are enrolling in Medicare Advantage, reducing the demand for FFS Medicare services. In addition, aggregate and per capita hospitalizations, which are a common source of referrals to home health care, have declined in recent years.”

The Report briefly discusses the increase in the use of telehealth services.  CMS is now requiring agencies to report telehealth services.

In 2023, CMS implemented a permanent reduction to the thirty (30) day period base rate of 3.925%, half of the amount calculated to maintain budget neutrality.  Even if the base rate is reduced by an additional 3.925%, MedPAC believes additional decreases to the base payment rate are needed due to the margins being reported by agencies.

The MedPAC Report is available here. 
 

Let's View Living as More Than the Quantity of Breaths We Take

By Barbara Karnes

Most medical professionals will try to keep you alive even though they know they won't succeed. Because that is what they are taught to do. 

Do you want it any other way? Do we want it any other way? Yes. We do, at least I do. 

I want the medical profession, the medical model we find in doctors’ offices and hospitals, to do everything possible to help me not only regain my health, but to return from an illness with the energy and ability to enjoy life. 

It doesn’t have to be perfect. Running, jumping, or even going back to work. But I do want to be able to respond, to enjoy, to feel, to interact. I even want to be able to laugh and to smile.

I’m willing to be limited in my physical functioning, even limited in my mental acuity but you, the medical professional, have to be honest with me. You have to tell me, up front, this is what your body is doing, this is how the disease is going to progress, this is what we can offer you, and this is what our treatment plan is likely or unlikely to achieve."

Give me ALL the options and possible outcomes so I can make a decision based on knowledge and truth. Let ME decide how much of a gambler I am in MY future and how I will end up living it.

Some people will say I am a fighter to my last breath and do EVERYTHING to keep breathing. Some people will say I’m not a gambler, I want to get as much living in while I have it, without being tied down to procedures with the hope that they work.

I want our medical profession, our medical model, to focus on PEOPLE that have diseases and health challenges. To focus on helping those people faced with health challenges to live their best life.

Today, our medical model treats DISEASES that people have. Its focus is on addressing whatever issue is threatening the heart's beating, the lungs' breathing, the kidneys' functioning. The focus seems to be on stopping whatever is trying to end a life. It seems there is a missing component here. Missing are considerations of whether life is just about breathing, circulation, and peeing; or is it about being able to experience, to feel, to enjoy what the heart, lungs and kidneys are giving us. 

Everyone and everything dies. Our bodies begin dying the moment we are born. The body is programmed to die. 

I’d like us to recognize quality of life as a part of healing. I would like those of us who have chosen the career of medicine to view living as more than the quantity of breaths we take. Do we make decisions on who lives and who dies? NO, but we do give people and their significant others honest, direct, clear, understandable information.
 

Hospice & Home Care Webinar Network Bi-Annual Buy 2 Get 1 Free Webinar Promotion (Runs All April)

Register for three webinars and automatically receive one of them for free! No coupon code is required, the sale will automatically apply to all eligible webinars once they are added to the shopping cart. 

Browse and register for webinars at http://fin-ed.info/springpromo
 

FTC Proposed Noncompete Rule and Its Impact on Home Care

Tuesday, April 11, 2023 | 11:00 a.m. MT

Please join us for an engaging and practical discussion with Littler attorneys Joshua Vaughn, Sherry Travers, Alex Frondorf and Matt Swanger, who will explain the Federal Trade Commission's proposed rule that would ban noncompete provisions (as well as functional equivalents) and its impact (or lack thereof) on employers in the home care industry.

Click to Register
 

In Win For Home-Based Care Providers, Health Care Workforce Bill Passes

Home Health Care News | By Patrick Filbin
 
A bill that passed Wednesday on the state level is being touted as a potential blueprint to mitigating home-based care workforce shortages nationwide.
 
In Frankfort, Kentucky on Wednesday, Gov. Andy Beshear passed the Kentucky Healthcare Workforce Development Act, legislation that aims to combat workforce shortages by building a public-private partnership that is designed to increase workforce training and education initiatives.
 
Joanne Cunningham, the CEO of the Partnership for Quality Home Healthcare (PQHH), told Home Health Care News this week that the bill felt different than others, in a positive way.
 
“It’s a public, private partnership that engages the private sector like health care organizations, insurers and others, as well as the government to try to incentivize all entities to work together on this,” Cunningham said. “I think that’s one of the reasons there’s such an appeal, certainly in the Kentucky state government, but also in Washington, D.C.”
 
The Kentucky legislation creates an investment fund with two primary programs. The first is a matching fund where, for every dollar a private-sector partner dedicates to the fund, a match is made by an educational program to fund scholarships for health care professionals.
 
The second program is designed to reward excellence among health care educational and training programs through certain benchmarks and measurements.
 
Earlier this month, the U.S. Senate sent out a request for information (RFI) for solutions to the national health care workforce crisis. PQHH was one of many organizations that submitted a letter suggesting solutions for these issues.
 
One of the solutions PPQH prosed was the bill from Kentucky.
 
“I’ve heard a number of members of the U.S. House and Senate recently talk about bipartisan solutions being the way we should be approaching these thorny policy issues,” Cunningham said. “The Kentucky proposal certainly lands squarely in that category and I think it’s getting a lot of interest for that reason, among many others.”

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