MedPAC Data Underscores Need for Targeted Medicare Reforms to Strengthen Program Integrity, Protect Patient Care

Washington, DC — The Partnership for Quality Home Healthcare today praised the Medicare Payment Advisory Commission’s (MedPAC) recommendation to target waste, fraud and abuse in the Medicare program. The home healthcare community supports efforts to target abusive billing behaviors, including recommendations to “conduct medical review activities in counties that have aberrant home health utilization”¦ [and] implement the new authorities to suspend payment and the enrollment of new providers if they indicate significant fraud.” Analysis of MedPAC data show that abusive billing practices are occurring in isolated pockets of the country. Indeed, of the nation’s 3,143 counties and county-equivalents, MedPAC has identified the 25 counties in which the highest levels of Medicare utilization and suspected abuse are occurring. As a result, the home healthcare community believes policy makers should undertake action to address targeted problems with targeted solutions. ”We are pleased with the Commission’s recommendation and their recognition that fraud and abuse is a targeted problem requiring targeted reforms,” said Billy Tauzin, former House Energy and Commerce Committee chairman and senior counsel to the Partnership for Quality Home Healthcare. “The home healthcare community has developed a set of detailed proposals to strengthen program integrity while protecting seniors, cost-efficient providers, and taxpayers alike. We look forward to working with MedPAC, Congress and the Administration to see these recommendations through, so that lasting change benefiting seniors and taxpayers can be achieved.” Meaningful reforms developed by the home healthcare community offer a targeted solution, including firm limits on episode and low-utilization payments, in order to prevent fraudulent activity before it takes place. In addition to these reforms, analysis of recently-released Medicare data indicates that a single payment reform relating to outlier claims that was proposed by the home healthcare community in 2009 achieved over $850 million in savings in 2010 alone — equivalent to nearly $11 billion in savings over the next 10 years. While the Partnership supports efforts to advance targeted reforms, the community expressed concern that recommendations calling for beneficiary copayments for skilled home healthcare services and rebasing of Medicare home healthcare rates could potentially limit patient access to the clinically advanced, low-cost care that an overwhelming majority of American seniors prefer. Instead of using blunt instruments, such as copayments for low-income seniors or across-the-board reimbursement changes, the Partnership asks lawmakers to instead focus on strengthening Medicare and Medicaid through program integrity and payment reforms. The home healthcare community is also concerned that the recommendations related to adding copayments and rebasing do not reflect the true cost of providing care and may not reflect recent cuts to home healthcare payments because of the lag in available cost report data upon which the recommendations are based. The Partnership has engaged Avalere Health to analyze provider margins using more recent data. This research is being undertaken in an effort to help inform the decision making process and to protect seniors and their providers from further cuts that could severely impact America’s home healthcare delivery system. Skilled home healthcare is the most cost-effective clinical care setting available for seniors today. Nearly 90 percent of American seniors prefer to age and receive treatment in their own home. Nationwide, more than 3.3 million Medicare beneficiaries receive skilled home healthcare to treat illnesses related to acute, chronic or rehabilitative needs.