November 26, 2018
Congress: Improve Medicare home health reforms to protect patient care
When it comes to health care, we expect our treatment decisions to be based on actual observed clinical evidence and real-world data. Yet, a newly finalized home health payment model from the Centers for Medicare & Medicaid Services (CMS) moves away from evidence-based decision making toward dangerous assumptions that could disrupt care for some of our nation’s most vulnerable seniors.
Millions of Medicare patients want to receive care in the comfort of their own homes. We owe it to them and America’s growing senior population to do everything possible to ensure their access to high-quality home health care is not compromised.
Unfortunately, this newly finalized Medicare home health payment model, called the Patient-Driven Groupings Model (PDGM), has great potential to threaten the continuity of care for an estimated 3.5 million homebound seniors across the country rely on to remain safely in their homes as they age while protecting their quality of life.
The new payment model – the most significant to home health in decades – 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. Through these assumed behavioral changes, Medicare is likely to arbitrarily cut reimbursement rates to home health agencies by 6.42 percent – equaling more than $1 billion – in the first year alone.