Congress must step up to protect Medicare home health care
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The year ahead will see continued change to health care with congressional and administration focus on the movement to value-based care, refinements to provider payment systems, and improvements in health care system efficiencies. In the Medicare program, reforms have been proposed to drastically change the way in which patients receive care and how home health providers are reimbursed for delivering these services.

For lawmakers new to Congress, it is important to understand the value the Medicare home health benefit brings to an estimated 3.5 million beneficiaries annually. For beneficiaries needing home health care, it is an essential benefit allowing them to keep their independence while receiving necessary clinical care. Every day, home health professionals deliver quality medical care – such as cardiac care, wound care, pain management and therapies – that was once only offered in a hospital or clinical setting.

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Those receiving care at home are some of our nation’s most at-risk populations. Data show they are older, sicker, more likely to live in poverty, to be a minority, and in need of more assistance with basic daily activities than the average Medicare population. To amplify these challenges, these patients are also more likely to live in rural areas with fewer health care options, underscoring the importance of home health access.

Fiscally, home health care just makes sense, reducing overall health care costs through disease management and the prevention of rehospitalizations and emergency room visits. Data show patients in a high-quality home health care program experience 26 percent fewer acute care hospitalizations and 59 percent fewer hospital days. When utilized after a patient receives a major joint replacement, for example, data show home health can save Medicare more than $5,000 per beneficiary.

Despite the growing need for home health to support shifting demographics and value-based care models, the Centers for Medicare & Medicaid Services (CMS) recently finalized a new payment model called Patient-Driven Groupings Model (PDGM) which could, if not refined, destabilize the delivery of care for some of our nation’s home health patients and their care providers.

If implemented as currently planned, PDGM will result in significant payment cuts of $1 billion (or 6.42 percent), based primarily on assumptions of provider behavior. The home health payment model should be based on observed evidence not assumptions; assumptions put patients in the crosshairs as CMS waits to see if their assumptions are indeed accurate. Assumption-based payment models are bad policy and will likely mean arbitrary rate reductions that could result in patients not receiving care they need in the home.

In response, bipartisan legislation introduced by Sens. Susan CollinsSusan Margaret CollinsPoll: McConnell is most unpopular senator Hillicon Valley: Lawmakers struggle to understand Facebook's Libra project | EU hits Amazon with antitrust probe | New cybersecurity concerns over census | Robocall, election security bills head to House floor | Privacy questions over FaceApp Trump angry more Republicans haven't defended his tweets: report MORE (R-Maine), John KennedyJohn Neely KennedyMORE (R-La.), Bill CassidyWilliam (Bill) Morgan CassidyFinding a path forward to end surprise medical billing Liberal think tank: GOP paid parental leave proposals are too narrow Senate GOP raises concerns about White House stopgap plan to avoid shutdown MORE (R-La.), Rand PaulRandal (Rand) Howard PaulUS-Saudi Arabia policy needs a dose of 'realpolitik' McConnell challenger faces tougher path after rocky launch Overnight Defense: Iran seizes British tanker in latest escalation | US, UK to discuss situation | Trump says 'no doubt' US downed Iranian drone after Tehran's denials | Pentagon's No. 2 policy official to leave | Lawmakers worry about Defense vacancies MORE (R-Ky.), Debbie StabenowDeborah (Debbie) Ann StabenowDemocrats grill USDA official on relocation plans that gut research staff USDA expected to lose two-thirds of research staff in move to Kansas City GOP Senate challenger in Michigan raises .5 million in less than a month MORE (D-Mich.), Doug Jones (D-Ala.) and Jeanne ShaheenCynthia (Jeanne) Jeanne ShaheenPoll: McConnell is most unpopular senator How to reduce Europe's dependence on Russian energy Epstein charges show Congress must act to protect children from abuse MORE (D-N.H.), S. 433, has been crafted to refine the PDGM approach to home health care. This legislation would require Medicare to institute rate adjustments only after behavioral changes actually occur and direct CMS to adjust payments based on evidence that assures the policy is based on sound evidence supported by the data.

In addition to having bipartisan support, this legislation is fully endorsed by the nation’s collective home health care community, which is committed to working with lawmakers to strengthen care delivery for the growing number of seniors who depend on the care we deliver daily. 

It’s also important to recognize this change is not happening in a vacuum. As these changes sit on the horizon, policymakers are considering the development of a unified post-acute care (PAC) payment model – bringing most post-hospital care settings under one payment umbrella. Knowing a unified PAC payment system is likely in our future, it is even more important for Medicare to “get it right” when it comes to PDGM – the largest payment reform home health has seen in two decades. Home health is vitally important and the PDGM model, if not corrected, would destabilize home health care at a time when our entire PAC system is evolving.

Our health care system must evolve and adapt as our nation’s demographics shift and resources vary, however we must not disrupt cost-effective and patient-preferred care for senior and disabled Americans by guessing what care may or may not be delivered in the future.

I commend the bipartisan group of senators for introducing S. 433 and look forward to working with this Congress to see this legislation passed into law. In doing so, our elected lawmakers can protect this vital benefit for those who need it most.

Keith Myers is Chair of the Partnership for Quality Home Healthcare.