November 27, 2018
Home Health Legislation Could Strengthen Payment Reforms, Protect Patients
Quality health care in the United States today is largely guided by evidence-based practice — meaning that providers make conscientious treatment decisions for their patients based on proven, scientifically grounded evidence that has been shown to be effective.
They don’t simply guess or make assumptions when it comes to care that could significantly affect someone’s life or health. They rely on data, evidence and facts.
When it comes to critical policy decisions, shouldn’t our nation’s policymakers do the same?
This fall, home health providers certainly hope that members of Congress will pass health care payment reform legislation that indeed does depend on facts. It’s important because, as it currently stands, a recently finalized home health payment model — the Patient-Driven Groupings Model — allows arbitrary rate reductions for home health providers based on assumptions — not actual behavior. If unaddressed by Congress, the PDGM stands to destabilize the home health care sector for the more than 3 million American seniors with Medicare who depend on the benefit annually.
Unfortunately, we already know from past experience that assumption-based rate reductions could lead to a drop in the use of home health services. And seniors need access to these services now more than ever before because of the rising tide of American seniors and an increased focus on ensuring patients receive care in the most clinically appropriate, lowest-cost setting — the home.
Absent a legislative solution, under the PDGM, the home health sector will be hit with Medicare reimbursement rate cuts of an estimated 6.42 percent — equaling more than $1 billion annually — starting in 2020.