As Congress wraps up for the year, the Partnership is again calling on Congress to enact the Pre-Claim Undermines Seniors’ Health (PUSH) Act of 2016, which would delay the implementation of the home health pre-claim review demonstration until Medicare and home health agencies are prepared to manage the process without disrupting care delivery.
Since the program was first rolled out in Illinois this summer, providers across the state have run into numerous delays and technical problems – including improper care denials and issues using the Medicare Administrative Coordinators (MAC) electronic submission system. This led to longer wait times and unnecessary delays in patient services.
The PUSH Act, orginially introduced by Reps. Tom Price, MD (R-GA) and Jim McGovern (D-MA), would delay pre-claim review for one year to allow Congress, CMS, and home health stakeholders to figure out how to strengthen the program through proper education and training. You can find out more about the bill here.
Fortunately, pre-claim review has already been temporarily suspended in several other states where it was slated to roll out. The PUSH Act would delay the pre-claim review for the rest of the country, and stop the program underway in Illinois.
The bill also calls on the Centers for Medicare & Medicaid Services to analyze the impact of the program and present a series of alternative measures for combating home health claims fraud – the original purpose of pre-claim review.
There is still time for you to help protect vulnerable seniors who depend on home health seniors – contact your member of Congress today and asking him or her to support this bill! Click below to get started:
Today is Election Day! Nearly 146 million Americans are currently registered to vote and millions across the country will cast their ballots not only for the U.S. President, but also for state, local, and county offices.
America’s senior citizens play a powerful role in the electoral process. Approximately 46 million Americans aged 65 + are currently eligible to vote and make up a large and diverse section of the electorate. Regardless of whom you cast your vote for, remember the 12 million seniors who receive home healthcare and the one million jobs the sector supports.
All members of the home-based care community should be able to fully participate in our nation’s democratic process via information distribution, voter registration, and absentee ballots. And thanks to Bring The Vote Home, a nationwide initiative that is surveying seniors on a wide range of issues while empowering them to engage fully in America’s electoral process, many seniors have already voted in this election!
Click here to find more information about your polling place and how to vote.
Earlier this month, CMS Administrator Andy Slavitt received a letter signed by every member of the Illinois Congressional delegation urging him to suspend the Pre-Claim Review Demonstration (PCRD) program in the state. Since the program began on August 3, providers have reported numerous improper care denials and technical issues with the state’s Medicare Administrative Contractor (MAC). Several of the program’s provisions, such as the requirement that physicians wishing to prescribe home-based treatment submit a detailed plan of care to the MAC before any care can be delivered, have been especially difficult to comply with.
“We urge CMS to immediately grant the state of Illinois the same PCRD delay that your agency has provided to Florida, Massachusetts, Michigan, and Texas, until education and guidance for home health providers, the state MAC, and patients are improved,” the letter reads. “If the lessons from Illinois prove that PCRD is not adequately developed for implementation in those states, then our constituents and provider organizations deserve the same consideration.”
Fortunately, CMS has already announced that it will suspend Pre-Claim Review in Florida and several other states after Illinois providers reported extreme difficulty complying with the new requirements. This comes as new reports show that between 60 and 80 percent of PCRD submissions have been rejected by the state’s MAC.
But there’s an even better fix. Recently, Representatives Tom Price (R-GA) and Jim McGovern (D-MA) introduced bipartisan legislation that would delay PCRD for at least a year. The Pre-Claim Undermines Seniors’ Health (PUSH) Act (H.R. 6226) suspends PCRD’s implementation in all states where it was set to begin – including Illinois – and requires the Department of Health and Human Services to submit a detailed analysis of the program along with a list of alternative measures to identify improper Medicare payments. The Partnership supports this legislation and remain committed to working with patients, providers, and the federal government to find a more effective solution to fighting Medicare fraud without jeopardizing quality home healthcare.
Since the Centers for Medicare & Medicaid Services (CMS) rolled out pre-claim review for home healthcare in Illinois, providers across the state have encountered numerous delays and technical problems. Across the home health community, we’re already receiving reports of improper care denials from the Medicare Administrative Coordinators (MACs) that review Medicare home health claims. Several other providers have also reported issues using the MAC’s electronic submission system – resulting in long wait times and unnecessarily delaying patient services.
Fortunately, there is a fix. Last week, Representatives Tom Price (R-GA) and Jim McGovern (D-MA) introduced bipartisan legislation to suspend and delay further extension of pre-claim review to other states so CMS can make adjustments to the program. The Pre-Claim Undermines Senior’s Health (PUSH) Act would implement an immediate, one-year delay to pre-claim review and require the Department of Health and Human Services to produce a report detailing the program’s impact on patients, providers, and the Medicare system.
Specifically, the PUSH Act:
- Delays the application of the demonstration in each State so it does not apply to episodes of care beginning earlier than one year after the earliest date that the demonstration was scheduled to begin in each State;
- Calls on the Secretary to suspend the demonstration in a State for at least one year if the pre-claim review demonstration is underway at time of enactment. This would extend the program’s delay to Illinois, which is currently the only state in which this program was implemented.; and
- Calls for a report to Congress no later than six months after the date of enactment to, among other things, analyze the impact of Medicare pre-claim review in any State in which it was implemented, describe the resources provided to physicians and home health agencies to conduct the demonstration, and outline alternative measures to identify improper payments with possible corrective actions
You can help protect vulnerable seniors who depend on home health seniors by emailing your Congressperson today and asking him or her to support this bill! Click below to get started:
Recent data sponsored by Bring The Vote Home (BTVH) found that the large majority of U.S. seniors oppose Medicare policy that requires a government contractor to approve claims for physician-prescribed home healthcare services — those often recommended by doctors for elderly patients following hospitalization.
While the data is concerning, as it proves that the majority of seniors oppose the recently implemented “pre-claim review” demonstration by the Centers for Medicare & Medicaid Services (CMS), we are not at all surprised that the senior population opposes government intervention when it comes to a patient’s health.
Healthcare decisions should be made by a physician and a patient — the federal government’s intervention only complicates, interferes and upsets the process.
The poll found that more than four-out-of-five seniors, 83 percent to be exact, of U.S. seniors think physicians should have the final word when prescribing home health. Because after all, a doctor knows significantly more about an individual patient’s situation than a government contractor.
Other key take-aways:
- Seniors think requiring a government contractor to approve claims for home health will result in care delays.
- Seniors think requiring a government contractor to approve care will increase costs – to both the patient and Medicare.
- Seniors most trust doctors and nurses to handle issues related to their healthcare.
The Partnership continues to monitor the impacts of the “pre-claim review” requirement as it is implemented this month in Illinois. In the meantime, we urge CMS to consider this data and the clearly expressed patient opinion that government interference in healthcare is wrong.
By Colin Roskey, Executive Vice President of Partnership for Quality Home Healthcare
The Center for Medicare & Medicare Services recently proposed a pre-claim review demonstration for Medicare home health services, upon which approximately 3.5 million Medicare beneficiaries depend.
The Partnership is echoing concerns expressed by more than 120 bipartisan lawmakers to a previously proposed, and very similar, pre-authorization policy. We are highly concerned the demonstration will result in unnecessary and unwarranted disruptions in seamless patient care, negatively affecting the weakest and sickest patient populations that depend on skilled home health care services to remain with their families and in their communities, not institutions.
Right now, the demonstration is set to start no earlier than August 1 in the state of Illinois, and shortly after, CMS will apply it to every claim made by every home health agency in Florida, Texas, Michigan and Massachusetts.
Why is this concerning?
- Medicare Administrative Contractors (MACs) are not fully prepared to manage the substantial increase in workload that will result from the pre-claim review demonstration. MAC staff will have to review 100 percent of all claims from all home health agencies in each state – a material new task requiring highly trained clinicians that can “turn around” each claim within 10 days.
- Home health agency (HHA) and physician workload and administrative costs will increase measurably.
- CMS has not armed physicians with the education and support needed to ensure they understand, and implement correctly, new pre-claim review policies and procedures.
- Pre-claim review policies will not appropriately prevent fraud and abuse.
- Home health stakeholders were given no opportunity to comment to CMS on the policies set forth in this demonstration project.
We continue to work with CMS and lawmakers in Congress to seek a solution that ensures that this demonstration is implemented in such a way that does not impede patient access to care, and that minimizes new burdens on home health agencies
We share CMS’s goal of eliminating fraud and abuse in the Medicare home health benefit, which we believe is a worthwhile and achievable goal. We just don’t agree that pre-claim review policies will have the desired result nor will they target bad actors who are currently abusing the system. More targeted reforms are needed to protect patients as well as the quality and honest providers who deliver care to American seniors in their homes every day.
The Partnership commends U.S. Senators Edward J. Markey (D-Mass.), John Cornyn (R-Texas), Michael Bennet (D-Colo.) and Rob Portman (R-Ohio) for introducing the Independence at Home Act, which will convert the Independence at Home (IAH) demonstration into a permanent national Medicare program.
The legislation has been lauded across the home health community for bringing primary medical services to Medicare beneficiaries with chronic and debilitating conditions in the comfort of their own homes. The Partnership previously praised the Independence at Home program for saving an estimated $25 million in its first year, or an estimated $3,070 per beneficiary, underscoring the value of home health services for aging Americans.
The program enables doctors and caregivers to provide primary care services to those in need of care at home, thereby reducing the number of unnecessary emergency room visits and avoidable hospitalizations and readmissions, and their associated costs.
The bill provides beneficiaries access to quality home care, giving them better control of their health and putting families at ease, while lowering healthcare costs. The Partnership thanks these lawmakers for recognizing the value of home-based care and urges the Congress to work with home health providers to develop additional programs to protect patient access to care in the home.
Last week the Alliance for Home Health Quality and Innovation released new data regarding the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Care for Joint Replacement (CJR) Model.
The data analysis, conducted by Dobson DaVanzo & Associates, comes just more than two months after CMS launched the bundled payment model for major joint replacements in 67 regions of the country.
The analysis looks at discharges between October 2011 and September 2014 for patients from the hospital to various post-acute care (PAC) settings who underwent major joint replacement without major complication or comorbidity. It found that by sending patients to home health as opposed to a facility based setting, hospitals can lower the cost of the episode payment by $5,000 and reduce the risk of patients returning to the hospital.
Across all (PAC) settings, eight percent of episodes contained a readmission, but that number drops to an average of five percent for patients who received home health after their hospital stay. This is compared to readmission rates of 12 to 15 percent for patients receiving rehabilitation in facility-based settings.
As hospitals across the country begin implementing the new CJR payment model, this new data demonstrates that home health is a key component to reducing overall costs and bettering patient outcomes.
As Memorial Day approaches, the brave service men and women who fought so loyally for our country are in our minds and hearts. We show utmost appreciation for their sacrifices that have kept our country safe and free.
Every day, home health agencies across the country strive to improve care and quality of life for our beloved veterans, and this Memorial Day, we hope to continue providing all those affected veterans with their rightful access to quality care in their preferred setting.
Millions of American seniors – including those who served our country – rely on Medicare home health to remain in their home as they age. To protect these noble veterans’ access to effective and efficient home healthcare, the Partnership is asking lawmakers to help prevent prior authorization requirements for home health, a process which would delay access to physician-prescribed home healthcare and increase costs for beneficiaries, the Medicare program and taxpayers.
Prior authorization has the potential to deter the timely delivery of care by requiring physician-ordered services to be reviewed and approved prior to care initiation, increase costs to Medicare by delaying hospital discharges, and limit the ability to reduce fraud and abuse.
To protect the well-being of veterans, and other seniors who depend upon access to care, we must raise awareness about the harms prior authorization can cause to the home health patients. We encourage everyone to support us in our journey to guarantee the health and happiness of American veterans by contacting their lawmakers to urge support:
We are pleased to release a new Home Health Value Kit: a guide that provides comprehensive information on the value of the Medicare home health benefit. Home healthcare provides clinically advanced, cost effective post-acute and chronic care management in the setting patients desire most – their home. So it’s critical for lawmakers, their staff, and other stakeholders to understand the benefits it has for patients, taxpayers and the Medicare program. Continue reading for a quick look into the kit and the information it offers:
This kit contains thorough information regarding home healthcare, from details about what home health care is, who receives it, information about the Partnership, and an outline of the human, clinical and fiscal value of the Medicare home healthcare benefit. You can also learn more about how you can support and empower the senior population through Bring The Vote Home, a national initiative designed to collect seniors’ opinions on a wide range of issues while simultaneously empowering both seniors and disabled Americans to engage fully in America’s electoral process.
Human Value of Home Health
Home health patients are older, poorer and sicker than the Medicare population as a whole:
- 4% of home health Medicare beneficiaries are older than 85
- 2% live with five or more chronic conditions
- 2% live at or below 200% of the Federal Poverty level
Clinical Value of Home Health
Patients in high quality home health and home-based care programs experience:
- 26% fewer acute care hospitalizations
- 59% fewer hospital bed days
- A total of 19-30% savings in medical costs
Fiscal Value of Home Health
Skilled home healthcare is widely recognized as cost effective:
- Medicare saves an average of $5,411 if home healthcare is the first post-acute setting utilized after a patient receives major joint replacement.
- The average cost of care in a skilled nursing facility is $449 per day or $26,940 for a 60-day stay compared to $2,674 for a 60-day home health episode.
Want to learn more?
To view the kit in its entirety, click here.