Congress: Support legislation to defend Medicare home health 

Since the start of the 116th Congress, reducing prescription drug-pricing has been a focal point for many lawmakers on Capitol Hill–and rightfully so. Legislative initiatives that strive to lower the cost of care should be applauded.

Yet as many policymakers and the wider public continue to focus on lowering the high costs of drugs, it’s easy to let other health care access issues fly under the radar. Case in point, a recently proposed reform to the Medicare program’s home health benefit that threatens the health care needs of millions of vulnerable seniors across the country.  

{mosads}To better comprehend the significance of these reforms, it’s important to first understand the home health benefit and the 3.5 million Americans it serves. As an indispensable pillar of support for patients in need of assistance to treat acute or chronic health problems, the Medicare home health benefit has proved critical care for patients with certain disabilities who have difficulty accessing outpatient care facilities and for others returning home after a hospital stay.

These beneficiaries are often the sickest and most vulnerable patients within the Medicare program. Relative to other beneficiaries, research shows home health patients are more likely to live in communities that are underserved, impoverished, and have fewer health care provider options. Home health beneficiaries are also by-in-large older and sicker that other patient populations. As America’s population continues to become demographically older, the number of patients in need of services covered by the home health benefit will only increase.

The Medicare home health benefit is also quite cost effective. By bringing stable and consistent care to patients in the comfort of their own home, the home health benefit has proven to prevent the frequency of rehospitalizations and emergency room visits–which saves Medicare millions every year.

Unfortunately, despite the effectiveness of the home health benefit in delivering services that are both value-based and fiscally sensible, a payment model recently finalized by the Centers for Medicare & Medicaid Services (CMS) threatens to destabilize the benefit and the patients it serves.  

The Patient-Driven Groupings Model (PDGM), which was finalized by CMS in November of last year, would trigger nearly $1 billion in reimbursement cuts for the home health benefit if implemented in its current form – in 2020 alone. These payment cuts would be based exclusively on unsubstantiated assumptions about provider behavior, rather than observable evidence or real-world data. Payment models–especially those that affect America’s most vulnerable patient population–cannot be based on arbitrary assumptions that may prove irrevocably inaccurate.

Luckily, as with the rising costs of prescription medications, lawmakers on both sides of the aisle have taken positive steps to address the problems associated with the new payment model. The bipartisan Home Health Payment Innovation Act of 2019 (H.R. 2573) was recently introduced by Representatives Terri Sewell (D-Ala.), Ralph Abraham (R-La.), Vern Buchanan (R-Fla.) in the House and Sens. Susan Collins (R-Maine) and Debbie Stabenow (D-Mich.) in the Senate (S. 433). In essence, this legislation would require Medicare to implement reimbursement adjustments which are founded on evidence-based changes in billing behavior, rather than arbitrary assumptions about provider behaviors which have yet to actually occur.

With strong support for both Senate and House bills from the nation’s home health care community, there is reason to be optimistic about the prospect of substantive changes to CMS’ originally proposed payment model.

As Congress continues to debate a series of reforms which could drastically shake-up America’s health care landscape, we must applaud lawmakers for taking steps to protect the home health benefit and the millions of patients who depend on it. Vulnerable beneficiaries need continuity and trust in their care, and I commend the lawmakers who have taken it upon themselves to ensure that stability.

Tim Rogers is Chair of the Council of State Home Care & Hospice Associations & President & CEO of the Association of Home & Hospice Care of North Carolina & the South Carolina Home Care & Hospice Association.