Posted March 31, 2023
During the last week of March, hundreds of stakeholders vied on behalf of home-based care in Washington, D.C., either physically or through Zoom.
Personal home care provider and advocate voices did so with an excitement for the future, fresh off the high of the president mentioning multiple times in a month.
Conversely, home health care’s voices advocated with a more somber tone, concerned about worsening patient access and businesses shuttering if the Centers for Medicare & Medicaid Services (CMS) doesn’t renege on payment cuts promised for next year and beyond. They did so on a stakeholder call with CMS representatives, where there were a lot of questions allowed, but not a lot of answers given in response.
“It doesn’t seem like the rate update addressed all the massive cost increases that have been occurring since 2021,” VNA Health Group President and CEO Dr. Steve Landers told those CMS reps.
By law, CMS is now required to offer more insight into how they are creating the payment rates for home health care agencies year by year. But Wednesday’s 90-minute Zoom meeting felt like satisfying the law and nothing more.
“It is very clear that we continue to disagree with the methodology that CMS employed to determine budget neutrality. The reality is that CMS has rebased payment rates to account for the reduction of therapy visits that came about solely because of PDGM,” NAHC) President William A. Dombi Bill Dombi said afterward in a statement shared with Home Health Care News.
Home health providers don’t want rate cuts for obvious, bottom-line reasons. But it also frustrates them because, as Dombi said, home health care is one of the few sectors that can actually create savings.
“CMS must withhold any further rate cuts to avoid the flaws of PDGM combining with uncontrolled cost inflation to destroy access to one of the few Medicare benefits that brings savings to the Medicare program,” he said.
Another cut incoming
In CY2023, home health providers saw a 0.7% aggregate payment bump compared to CY2022. But a cut was disguised as a bump, really, because of the inflationary adjustments included.
Essentially, providers are seeing a 4% cut to payments this year. Heading into Wednesday’s Zoom Call, sources told HHCN they believed they’d likely see an even worse proposed rule this June than they did last year.
After Wednesday, that seems even more likely.
“Labor costs for nurses home health aides are up – in some places, you can’t even find folks,” he said. “And one of the reasons you can’t find them is because we’re competing with the hospitals. And the hospitals have differential treatment by CMS under wage index policy. So, for example, hospitals might be using an imputed rural floor on their wage index calculation, they might reclassify their wage index. With the transition policy from the old wage index system to new one, hospitals were given a longer runway.”
Here are the three takeaways that NAHC and the Partnership for Quality Home Healthcare (PQHH) came away with after the call.
– “CMS does not believe it is required to demonstrate how certain changes in provider behavior affected expenditures under PDGM and the calculation of the revised payment rates for CY2023. CMS’ justification for this position is that examining overall expenditures under PDGM equates to assessing the impact of behavior changes.”
– “CMS acknowledged that it has discretion in when and how any adjustments are applied to future payment years and that it exercised that discretion in reducing the permanent adjustment for 2023 from 7.85% to 3.95% and did not apply any temporary adjustment due to its concerns about the impact on providers.”
– “CMS stated that it is monitoring the impact of the rate changes on care and noted consideration of cost increases in the current inflationary environment.”
Home health leaders from across the country are hoping that their Washington, D.C., trips are not all for naught.
Source: Nome Health Care News
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