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 CollinsSenate GOP poised to go 'nuclear' on Trump picks Overnight Health Care: CDC pushes for expanding HIV testing, treatment | Dem group launches ads attacking Trump on Medicare, Medicaid cuts | Hospitals, insurers spar over surprise bills | O'Rourke under pressure from left on Medicare for all Dem group launches ads attacking Trump's 'hypocrisy on Medicare and Medicaid cuts' MORE (R-Maine), John KennedyJohn Neely KennedyMORE (R-La.), Bill CassidyWilliam (Bill) Morgan CassidySenators ask CBO to review options for preventing surprise medical bills Five things to watch for in Trump's 2020 budget Overnight Health Care - Presented by Kidney Care Partners - FDA chief Scott Gottlieb resigns | House Dems to take up drug pricing bills next week | Planned Parenthood, doctors group sue over Trump abortion rule MORE (R-La.), Rand PaulRandal (Rand) Howard PaulHillicon Valley: Mueller delivers report, ending investigation | FEMA exposed info of 2.3M disaster survivors | Facebook asks judge to toss DC privacy lawsuit | Trump picks his first CTO | FCC settles lawsuit over net neutrality records Transparency advocate says government agencies face 'use it or lose it' spending Republicans need solutions on environment too MORE (R-Ky.), Debbie StabenowDeborah (Debbie) Ann StabenowChris Evans talks NATO, Marvel secrets on Capitol Hill Overnight Health Care: Senators grill drug execs over high prices | Progressive Dems unveil Medicare for all bill | House Dems to subpoena Trump officials over family separations Senators grill drug execs over high prices MORE (D-Mich.), Doug Jones (D-Ala.) and Jeanne ShaheenCynthia (Jeanne) Jeanne ShaheenSenate Dems petition Saudi king to release dissidents, US citizen Senators offer bipartisan bill to fix 'retail glitch' in GOP tax law Overnight Energy: EPA moves to raise ethanol levels in gasoline | Dems look to counter White House climate council | Zinke cleared of allegations tied to special election 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.