MEDPAC Commissioners Discuss Medicare Home Health Payment Overhaul

Even as home health agencies prepare to implement the deep payment cuts and regulatory changes called for in the health reform law and 2011 payment rule, MEDPAC’s Commissioners are considering recommending major PPS payment changes in their Spring 2011 report to Congress.   At their November meeting, the Commissioners considered a presentation by home health analyst Evan Christman  on Improving Incentives and Safeguards for the Home Health Benefit .

Christman focused much of his presentation on variations in profitability and how in particular financial performance tracks to cases with therapy use.  Christman also provided detailed data on what he charatcerized as a 48% growth in home health episodes with no prior hospitalization or other post acute services.   The rate of growth for these types of cases, he informed the Commissioners, is 14 times the rate of growth for home health as a post acute care services.  Supply, he said, is expanding to take care of less severely ill patients.   The Commissioners were clearly – by their comments – taken back at this.

Christman recommended the the Commissioner endorse a “redistributive payment recommendation” that would reduce percentage of overall dollars going to cases with therapy in favor of non-therapy and dual eligible patients.  He also  recommended a 3% adjustment for dual-eligibles   Finally, he recommended consideration of a co-payment, specifically on home health cases with no prior hospitalization.   A lengthy and instructive discussion of home health trends, payments and value ensued – all of which can be found on the meeting transcript –beginning on page 211.

While ether are some things in the MEDPAC discussion that this association has  supported (dual eligible adjustments), a review of the transcript reveals we still have both an image and a substance issue when it comes to (many) MEDPAC Commissioners and our services.

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Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

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