Paying it Forward

The home care community is often called upon to predict the future. Looking into our crystal ball, we can predict that the budget crisis will continue to pressure Congress for more spending cuts, especially in the Medicare and Medicaid programs.

Many of our nation’s seniors will eventually face difficult health issues, such as Alzheimer’s, heart and respiratory diseases, diabetes, Parkinson’s, and other chronic conditions, while millions of younger patients with health challenges that require comprehensive care will also face the dilemma of health care financing. Current trends will continuously drive health care utilization higher than at any point in our country’s history.

It is clear new paradigms and solutions are needed to tackle this crisis.

The Centers for Medicare and Medicaid Services-driven outcomes- and evidence-based health care models are emerging as new paradigms for the way providers serve patients in the United States. In our industry, we have seen this metamorphosis primarily in the home health sector. However, trends indicate that every segment of health care will undergo a similar transition.

“Pay-for-performance” initiatives are already underway for home health, physicians, hospitals, skilled nursing facilities, Medicare Advantage and End-Stage Renal Disease. The Medicare Modernization Act required P4P measures reporting in order for hospitals to receive a market update in home health.

In November 2005, the Senate passed the Deficit Reduction Omnibus Reconciliation Act (S. 1932), which includes a package of P4P-related measures for Medicare. These provisions are based on another U.S. Senate bill, the Medicare Value Purchasing Act (S. 1356), which would award incentive payments to Medicare providers for reaching health care quality thresholds or improving the current level of care. Senate Finance Committee Chairman Charles Grassley, R-Iowa, and Ranking Member Max Baucus, D-Mont., cosponsored S. 1356 to be budget-neutral except for the costs of developing performance measures.

AAHomecare’s Home Health Council established a task force that developed P4P principles with a framework that closely resembles the Grassley-Baucus model. Like the AAHomecare model, the Senate bill also stipulates incentive payments for reaching a threshold level of performance. Our membership has also embraced the outcomes-based quality improvement process through involvement with state quality improvement organizations.

Recently, CMS contracted with Abt Associates to create a P4P demonstration project for skilled nursing facilities. In September 2005, Abt Associates also worked with CMS to produce the draft “Quality Standards for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies,” required as a part of national competitive bidding (aka restrictive contracting). You can review AAHomecare’s comments to CMS on the quality standards at www.aahomecare.org.

Once DMEPOS quality standards are collected in a uniform manner and home medical equipment is evaluated by CMS on whether it meets these standards, the HME sector would be primed to become more outcomes-oriented in the future.

What can HME providers do? First of all, stay informed throughout the CMS-directed quality standards process (see www.aahomecare.org and www.cms.hhs.gov for more information). Some of these standards are likely to become the measures used for P4P for HME.

Further, we should all participate in demonstrations and surveys, promoting the collection of data that confirms the value and cost-effectiveness of home care. Our industry needs to prove that what we do for patients is necessary and provides the best patient outcomes in order to receive payment for Medicare and Medicaid beneficiaries.

As Congress and CMS search for solutions to America’s health care crisis, there is an ever-increasing pressure for the home care industry to provide data on costs for providing services, equipment, maintenance and repairs. We want legislators and regulatory agencies to look to the home care community as a valuable health care segment and solution to America’s health care crisis.

Kay Cox is president and CEO of the American Association for Homecare, Alexandria, Va. For more information about AAHomecare, visit www.aahomecare.org, or call 703/836-6263.