Health professionals weigh in on
 possible changes to Medicare funding

Cuts to home health agencies would be ‘a step in the wrong direction,’ say AFT’s healthcare leaders

AFT NURSES AND HEALTH Professionals weighed in on a proposed rule by the Centers for Medicare & Medicaid Services (CMS) concerning an update to the home health prospective payment system rates.

AFT NHP sent a letter in September to CMS administrator Marilyn Tavenner, asking that funding for home health agencies not be cut below 2014 levels. “Our members are committed to shaping a healthcare system that serves the needs of communities and puts patients first,” the letter states. “High-quality home care is an integral part of a healthcare system that meets those goals. However, the proposed net cut to home health agencies of $58 million is a step in the wrong direction.”

The Affordable Care Act calls for a phased-in adjustment, or “rebasing,” of home health payments based on the number of visits, mix of services and other factors. The ACA also draws upon the Medicare Payment Advisory Commission’s expectation that Medicare agencies will increase the efficiency of services at a rate roughly equal to private sector efficiency gains, which suggests that as the agencies’ productivity increases, their need for Medicare reimbursement should decrease.

As a result, the ACA calls for Medicare home health payments to be reduced by a “productivity” adjustment, starting in 2015. According to AFT NHP, “this reduction in payments to home health agencies is troubling, especially given the great potential for high-quality home care to help keep people well and reduce unnecessary health spending—two important goals of the ACA.”

The proposed cuts will make it even more difficult for homebound patients to receive the care they need to stay out of hospitals or skilled nursing facilities, the letter states.

AFT NHP is encouraging CMS to revisit the methodology used to calculate the proposed cuts and make every effort to ensure that home health agencies have adequate funding to deliver safe and effective care.

The letter also calls on CMS to allow advanced practice registered nurses to practice to the full scope of their education, training and licensure by letting them certify face-to-face visits with their patients. To date, in order for Medicare to reimburse a patient’s home health services, a doctor must document that a face-to-face visit with the patient took place. The requirement is redundant, however, given that APRNs currently are conducting face-to-face visits, the letter says.

In addition, AFT NHP is asking CMS to provide frontline caregivers a seat at the table in the development of a home health value-based purchasing program. “Bedside nurses can provide valuable insight into the types of measures that indicate high-quality care,” the letter says.

Healthwire, Winter 2014 Download PDF (430.25 KB)
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