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 CollinsThe 17 Republicans who voted to advance the Senate infrastructure bill Senate votes to take up infrastructure deal Gyms, hotels, bus companies make last-ditch plea for aid MORE (R-Maine), John KennedyJohn Neely KennedyMORE (R-La.), Bill CassidyBill CassidyThe 17 Republicans who voted to advance the Senate infrastructure bill Senate votes to take up infrastructure deal GOP, Democrats battle over masks in House, Senate MORE (R-La.), Rand PaulRandal (Rand) Howard PaulOnly two people cited by TSA for mask violations have agreed to pay fine Senators reach billion deal on emergency Capitol security bill GOP Rep. Cawthorn says he wants to 'prosecute' Fauci MORE (R-Ky.), Debbie StabenowDeborah (Debbie) Ann StabenowEnergy chief touts electric vehicle funding in Senate plan Senate passes bill to award Congressional Gold Medal to first Black NHL player The glass ceiling that diverse Senate staff still face MORE (D-Mich.), Doug Jones (D-Ala.) and Jeanne ShaheenCynthia (Jeanne) Jeanne ShaheenEquilibrium/ Sustainability — Presented by NextEra Energy — Clean power repurposes dirty power CIA watchdog to review handling of 'Havana syndrome' cases Frustration builds as infrastructure talks drag 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.