Posted on Saturday, March 16, 2019 8:06 PM
On April 1st and 2nd, home health advocates and employees will march on Washington fighting for a fair home health payment system.
One of the key issues home care advocates need to discuss with their members of Congress is the Patient-Driven Groupings Model (PDGM). Finalized by CMS last year, PDGM is the most significant payment change to the home health system in 20 years. As part of the Bipartisan Budget Act of 2018 (BBA), Congress called for any changes in the home health prospective payment system (PPS) to be budget neutral, so that any changes would result in the same federal outlay as is currently projected to occur with the current PPS. To achieve this, CMS was authorized to adjust reimbursement rates utilizing assumptions of how provider behavior might change in a new payment model.
If implemented as presented, PDGM will make payment adjustments based on behavioral assumptions as instead of observed evidence or actual provider billing behaviors. The new payment structure could result in a 6.42 percent payment reduction in 2020 – equaling an estimated $1 billion. Without the elimination of the behavioral assumption cut, PDGM could lead to instability for all providers, threaten access to care and harm the Medicare home health program for seniors.
“The transition to the new PDGM payment model promises to be disruptive for home health agencies that have operated under the current model since 2000. It is not prudent to magnify that disruptive impact by reducing payment rates based on pure assumptions on how agencies will react. The legislation will provide protection from such disruption and ensure continued access to care for nearly three and a half million Medicare beneficiaries who rely on home health services every year,” says Bill Dombi, President of the National Association for Home Care & Hospice.
Source: NAHC report
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