Big Push for Home Health Payment Model Rethink

WASHINGTON, D.C. (November 28, 2018)—The National Association for Home Care & Hospice (NAHC) will co-sponsor with state home health associations a series of 12 one-day seminars around the country in early 2019, exploring the Patient-Driven Groupings Model (PDGM), what it will mean for home health, and how businesses can adapt to some of the most consequential regulatory changes the industry has seen.

The newly finalized Medicare home health payment model is believed to threaten continuity of care for an estimated 3.5 million homebound seniors across the U.S.

Experts, such as NAHC’s William Dombi and others, say the new payment model makes changes to Medicare reimbursement for home health services based on “untested assumptions about providers’ billing behavior, rather than any actual, evidence-based changes triggered by the new payment model that affect overall Medicare spending on home health services.” And, they say Medicare is likely to arbitrarily cut reimbursement rates to home health agencies by 6.42 percent in the first year.

Three bills have been introduced in the House and Senate that, if passed, would require Medicare to adjust reimbursement rates only after behavioral changes by home health agencies actually occur. The bipartisan bills (S. 3545, S.3458, and H.R. 6932), sponsored by Sens. Susan Collins (R-Maine), Debbie Stabenow (D-Mich.) and Bill Nelson (D-Fla.), John Kennedy (R-La.) and Bill Cassidy (R-La.), and Reps. Ralph Abraham (R-La.), Garrett Graves (R-La.), Scott DesJarlais (R-Tenn.), Vern Buchanan (R-Fla.), and Terri Sewell (D-Ala.) would stabilize access to care while the Centers for Medicare & Medicaid Services and stakeholders work together to improve Medicare payment reforms.

Home health leaders representing the Council of State Home Care & Hospice Associations, NAHC, the Partnership for Quality Home Healthcare and 11 state home care associations visited Capitol Hill Wednesday, November 28, to advance the bipartisan, bicameral Medicare home health legislation. They want to see Congress act during the final weeks of this legislative session.

“With more than half of home health agencies bracing for such sharp and unexpected reimbursement reductions, we have raised constructive concern with both CMS and Congress that these cuts may lead to unintended consequences—most notably a disruption in care for beneficiaries requiring home health to prevent expensive rehospitalizations, manage chronic conditions and assist seniors following an acute episode of care,” said Dombi, in a press release from the Partnership for Quality Home Healthcare.

Home health leaders stress the new payment model should be treated like other Medicare payment systems. A behavioral assumption cut without data is not sound payment policy. CMS, in issuing the Skilled Nursing Facility (SNF) model, refused to make assumptions about provider behavior, stating that it would “not make any attempt to anticipate or predict provider reactions to the implementation of the proposed [payment model].” The home health payment model should be treated in the same way as other payment models: by using a data-drive approach to behavioral assumptions, the Partnership explained.

A website devoted to updating the public about the PDGM conferences has launched at pdgm2019.nahc.org. The dates and cities for each conference are announced below. Pricing and the specific venues for each conference will be announced soon.

• Orlando, Florida—January 23, 2019
• Kansas City, Missouri—January 24, 2019
• New Orleans, Louisiana—February 5, 2019
• Portland, Oregon—February 6, 2019
• Valley Forge, Pennsylvania—February 7, 2019
• Denver, Colorado—February 13, 2019
• Columbus, Ohio—February 21, 2019
• Charlotte, North Carolina—February 27, 2019
• Chicago, Illinois—March 5, 2019
• Boston, Massachusetts—March 12, 2019
• Los Angeles, California—March 19, 2019
• Dallas, Texas—March 26, 2019

“PDGM will revolutionize how home care operates,” Dombi said. “Every Medicare home health agency must carve its own path to the new payment model and attending one of these very special seminars is the absolute best way to make the transition to PDGM smooth and successful. An agency not prepared for PDGM is not prepared for the future.”

Faculty for the PDGM conferences will be drawn from the foremost experts in home health, who will provide expert guidance on what these rules changes will mean for every type of agency, according to NAHC. The conferences will provide an analysis of the impact that PDGM will have on the operations, finance, business analytics, technology and clinical sectors of an agency. Material will be available for conference attendees to download, and a studio-based video of the conference program will be made available at a later date. Please stay tuned for more information.

Visit nahc.org for more information.