Congress Repealed the Medicare Home Health Copayment Because It Increased Costs. So Why Are They Considering It Again?

Posted on May 3, 2013 by partnership

In 1972, Congress passed an amendment repealing a 20-percent copayment to beneficiaries who received home healthcare under Part B citing copayments as “a financial burden to many elderly persons living on marginal incomes.” The coinsurance requirement lead to increased hospital costs and was found to discriminate against patients.

Similarly, our nation’s 3.5 million Medicare home healthcare beneficiaries are today facing the prospect of a copayment on home health services, most recently proposed in the Obama Administration’s FY2014 budget plan. Despite evidence that copays actually increase Medicare costs by forcing patients to seek care in costlier institutional settings, some lawmakers are looking at instituting increased fees on seniors in need of home health as a means for generating federal cost savings.

A recent Forbes column details some of the myriad reasons a home health copay is bad policy and why lawmakers should instead look for Medicare savings by targeting federal dollars lost to fraud and abuse.

The Partnership strongly opposes the reimposition of a beneficiary copayment in the Medicare home health benefit. Instead, it is encouraging Congress to advance targeted reforms that do not harm innocent seniors.

Letter to President Obama: Support Program Integrity Reform Instead of Across-the-Board Cuts and Higher Costs for Seniors

Posted on April 12, 2013 by partnership

The Partnership for Quality Home Healthcare supports program integrity reforms in the Medicare program specifically targeting fraud and abuse to prevent these behaviors before they can occur.

As a member of the Fight Fraud First! coalition, the Partnership is working with others to ask policy makers to make every effort to eliminate waste, fraud and abuse from the Medicare program before cutting Medicare payments or asking beneficiaries who rely on these important services to shoulder more out-of-pocket costs.

In a letter sent to President Obama this week, Fight Fraud First! urged the Obama Administration to support program integrity reform instead of across-the-board cuts and increased costs for our nation’s vulnerable seniors. Read the letter below:

April 10, 2013

President Barack Obama

The White House

1600 Pennsylvania Avenue, NW

Washington, DC 20500

Dear President Obama,

As a coalition of groups representing millions of older Americans, persons with disabilities, minorities, veterans and healthcare providers – founded on the premise that eliminating waste, fraud and abuse in the Medicare and Medicaid programs should be a priority for lawmakers to reduce health care spending – we urge your Administration to support program integrity reform instead of across-the-board cuts and increased costs for our nation’s vulnerable seniors.

We respect that leaders in Washington have to make tough decisions when it comes to securing America’s financial future. While progress must be made, we ask that lawmakers strongly consider advancing policy solutions that generate savings through targeted efforts to prevent fraudulent activity and wasteful spending in the Medicare program, and increase successful programs designed to recoup government funds lost to fraud and abuse.

As you prepare to release your FY 2014 budget, we respectfully ask you to propose targeted solutions to prevent improper and fraudulent payments before they occur. Strengthening the current pay-and-chase system through program integrity reforms is a solution that makes sense for older adults, taxpayers and our nation’s health care delivery system.

Data suggest up to an estimated ten percent of Medicare funding is lost to waste, fraud, and abuse each year.1 Successful programs created by your Administration have addressed system weaknesses and yielded billions of dollars in Medicare savings. We believe even more can be done. Therefore, we ask that you support targeted approaches to combating fraud and abuse to protect our nation’s nearly 50 million Medicare beneficiaries.

Our organizations came together in the collective belief that correcting inefficiencies in the Medicare program is the most prudent approach to reducing federal spending within the Medicare program. Rather than turning to Medicare cuts or higher premiums or copayments that unfairly burden seniors, we urge the federal government to achieve savings by implementing policy solutions that stop waste, fraud, and abuse before it starts.

We encourage you to reject increased out-of-pocket costs or cuts to Medicare that would restrict beneficiary access or reduce benefits, and instead call for program integrity reforms that protect beneficiaries and save valuable taxpayer dollars.

Sincerely,

AARP

American Autoimmune Related Diseases Association

Caregiver Action Network

HealthHIV

National Association for Uniformed Services

National Grange

National Hispanic Council on Aging

Partnership for Quality Home Healthcare

RetireSafe

Veterans Health Council

Vietnam Veterans of America

1 U.S. Government Accountability Office. Medicare: Program Remains at High Risk Because of Continuing Management Challenges. GAO-11-430T. March 2, 2011.

CMMI Director Touts Value of Home Health

Posted on April 1, 2013 by partnership

In a hearing before the Senate Finance Committee last week, CMS’ Center for Medicare and Medicaid Innovation (CMMI) Director, Dr. Richard Gilfillan, was the sole witness at a recent Senate Finance Committee hearing on ways to reform Medicare and Medicaid. In his written testimony and during the hearing, Dr. Gilfillan sited the value of home healthcare in new delivery models for Medicare and Medicaid.

He further described how demonstration programs involving home health are working to improve outcomes and reduce Medicare costs.

In his written testimony, he states:

“Innovation Center initiatives include the Independence at Home Demonstration, created by the Affordable Care Act, which uses home-based primary care teams designed to improve health outcomes and reduce expenditures for Medicare beneficiaries with multiple chronic conditions. Under the Independence at Home Demonstration, selected primary care practices will provide home-based primary care to targeted chronically ill beneficiaries for a three-year period. Participating practices will make in-home visits tailored to an individual patient’s needs and preferences with the goal of keeping them from being hospitalized.”

Click here to see the video recording of the hearing.

Cleveland Clinic Journal of Medicine Focuses on Home Health

Posted on March 19, 2013 by partnership

Last month, the Cleveland Clinic Journal of Medicine (CCJM) partnered with the Alliance for Home Health Quality and Innovation to release a supplement to the CCJM, which examined the critical role home health has in the nation’s healthcare delivery system. Leading medical experts and home health professionals presented outcomes from innovative approaches to home health and offered a variety of perspectives on topics such as:

• Transitional care
• Chronic disease management
• Palliative care
• Health care technology

At a Capitol Hill briefing, supplement authors discussed how home healthcare could be better utilized across healthcare systems to streamline care, improve patient outcomes and reduce healthcare costs. Key take-aways from the presentation include:

• Better management of the care transition process – such as moving the patient from the hospital to home health – can result in measureable outcomes including a decrease in the average readmission rate.
• Because Americans are living longer and want to remain in their homes, it is especially important that we find better ways to coordinate care at the time of discharge so that chronically ill older Americans can be cared for in a more clinically and cost-effective way.
• There is great evidence that supports the value of home health in providing supportive and recuperative care services in our nation’s health care system.
• As the prevalence of seniors requiring care for chronic and advanced illnesses grows, more integrated systems and increased coordination will be critical to ensuring quality of life for the Medicare population.

In addition to serving as a resource to policy makers and thought leaders, the supplement is a peer-reviewed monthly medical journal and continuing-education product, which offers practical and clinical information relevant to a variety of healthcare fields.

To access the full supplement, Optimizing Home Health Care: Enhanced Value, Improved Outcomes, visit here.

More Home Health Patients Facing Greater Healthcare Challenges

Posted on February 28, 2013 by partnership

According to the U.S. Department for Health & Human Services’ National Center for Health Statistics, an estimated 27 million people will need some type of long-term care by 2050. Of those 27 million, the majority will receive long-term care in the community. Skilled home healthcare is a leading provider of formal, community-based care.

The NCHS report states, “Older Americans will increasingly constitute a larger percentage of the population in the future—from about 12% in 2006 to almost 20% in 2030. The majority of people using home health and hospice care services are over age 65 years. Most of them have multiple chronic conditions, and home health and hospice care services enable many of them to receive services in their homes and communities.”

In addition to the rapid growth in Americans eligible for Medicare, the program’s home health care beneficiary population is generally the sickest, poorest and most vulnerable in the Medicare program. When compared to all other Medicare beneficiaries, home health patients typically face greater challenges.

Source: Avalere analysis of the Medicare Current Beneficiary Survey, Access to Care file 2010.

The demographics of the Medicare home health population further illustrate the valuable role home health has now, and in the future, in keeping seniors healthier and happier in their home environment.

Fight Fraud First! to Protect Medicare and Seniors

Posted on February 5, 2013 by partnership

Who is Fight Fraud First!

Fight Fraud First! is a collaborative effort among advocates, seniors, persons with disabilities, military veterans, and minority communities. The coalition advocates that every effort should be taken to eliminate waste, fraud and abuse from the Medicare and Medicaid programs before any cuts are made to beneficiaries who rely on these important services.

Call to Action

In December of 2012, the coalition issued letters to House and Senate Leadership urging Congress to support program integrity reforms rather than across-the-board cuts or increasing seniors’ out-of-pocket costs. FFF! supports targeted reforms that stop improper and fraudulent payments before they occur.

Additionally, the coalition is urging concerned Americans to sign a petition to Congress with the same request: to eliminate the bad actors from Medicare who cause rampant waste, fraud and abuse in the system. The petition has more than 4,000 signers to date, but we need more to help make our voices heard in the halls of Congress. Please visit the website and tell Congress to fight fraud first!

Progress in Home Healthcare

The Partnership and other leaders in the home care community have crafted a proposal entitled the Skilled Home Health and Integrity and Programs Savings (SHHIPS) Act that outlines program integrity reform and aims to stop waste, fraud and abuse by preventing it before taxpayer dollars ever fall into the wrong hands.

With targeted reforms, Congressional action and support from the healthcare community, we can eliminate fraud and protect our nation’s seniors.

Bipartisan Group of Senators Call for Stronger Efforts to Fight Fraud

Posted on January 15, 2013 by partnership

In a press statement last week, Senators Max Baucus (D-MT), Tom Carper (D-DE), Tom Coburn (R-OK), and Orrin Hatch (R-UT) called for Medicare program integrity improvements. Their statement was in response to a recent report by the Office of the Inspector General (OIG), which calls for more aggressive efforts to stop Medicare fraud and abuse before it occurs.

The bipartisan group of Senators called for stronger fraud detection processes within the Medicare Drug Integrity Contractor (MEDIC) program, which the OIG said is not doing enough to identify preventable cases of fraud.

Detecting Medicare fraud before it occurs is imperative to protecting beneficiaries, taxpayers and the Medicare program, which ensures access to healthcare for nearly 50 million Americans. Bipartisan support in the Senate for tougher policies is a significant step to strengthening fraud prevention efforts.

Action in the Home Health Community

A strong advocate for the prevention of Medicare fraud before it can occur, the Partnership has collaborated with other community leaders on a detailed proposal to strengthen the Medicare home health benefit by targeting waste, fraud and abuse within the system. The Skilled Home Healthcare Integrity and Program Savings (SHHIPS) proposal calls for such reforms as a more rigorous claims review process, stronger conditions of participation, and payment “guardrails” to prevent aberrant claims from being paid.

Program integrity reforms are key to reducing wasteful spending and protecting innocent beneficiaries from policy measures that could negatively impact senior care such as across-the-board cuts or increased copayments.

The Partnership is also a founding member of Fight Fraud First!, a collaborative effort of advocates for seniors, persons with disabilities, military veterans, and minority communities. The FFF! Coalition advocates that every effort should be taken to achieve savings by eliminating Medicare and Medicaid waste, fraud and abuse before any funds are taken from Medicare beneficiaries or the benefits on which they depend.

American Action Forum Primer on VA Home Based Primary Care

Posted on November 9, 2012 by partnership

By Doug Holtz-Eakin, President, American Action Forum

Two recent studies suggest that home healthcare should be given a close look in reforming Medicare. The American Action Forum recently released a paper by Emily Egan entitled, “VA Home Based Primary Care Program: A Primer and Lessons for Medicare.” The goal of the primer was to summarize the working of the Department of Veterans Affairs (VA) Home Based Primary Care (HBPC), shed some light on its effectiveness, and draw any lessons for home health in the Medicare program.

HBPC began in 1972 (with 6 demos) and serves veterans with chronic and disabling conditions who need more care than periodic doctor visits. It uses teams of medical directors, nurses, social workers, dietitians, psychologists, pharmacists and rehabilitative therapists to provide integrated and coordinated care for the patient.

The program appears to have been a success in that participants experienced a drop of 62 percent in hospital days, 88 percent in nursing home care days, and 24 percent in overall care costs. In addition, on study concluded that participants in the HBPC program had higher scores for “health related quality of life” than a comparable control group.

All of this suggests that Medicare ought to take a close look at HBPC. However, Medicare as it is currently structured is not set up to simply copy the VA approach, as the home health benefit has different eligibility requirements and services. Medicare’s home health benefit is focused on the homebound; not the larger number of chronically ill patients. Moreover, Medicare permits up to 60 days of care, while the HBPC has unlimited visits as long as they are medically appropriate. Finally, Medicare is more narrowly focused on health and rehabilitation as opposed to the coordination of a team in the HBPC. In short, taking the HBPC approach would expand the population, number of visits, and services available – a major expansion for Medicare that would have to be offset by cost-savings obtained.

It should be noted, that there is some hope on this front as well. A recent “Clinically Appropriate and Cost-Effective Placement” (CACEP) report from the Alliance for Home Health Quality and Innovation suggests that placing post-acute care patients in the most clinically appropriate setting can deliver large savings for the Medicare program by significantly reducing hospital admission and readmission rates. In some cases, home healthcare is the most appropriate setting.

What’s the bottom line? The combination of the two studies raises the tantalizing possibility that a HBPC-like approach to the Medicare home health benefit might provide more and better care, and at the same time lower the cost of Medicare. It is a lofty goal, but with Medicare’s looming insolvency, policymakers need to consider major changes with the potential for major results.

NCOA Survey on Aging Shows Most Seniors Hope to Remain at Home

Posted on August 13, 2012 by partnership

Results from a recent survey by the National Council on Aging (NCOA) show that a majority of older Americans hope to age in place.

There’s No Place Like Home

Some of the reasons for wanting to remain at home include liking where they currently live (85 percent), having friends nearby (66 percent) and not wanting to deal with the hassle of moving (50 percent).

Economic Anxieties

The survey also found that finances play a large role in shaping seniors’ preference to remain at home:

More than half (52 percent) of low- and moderate-income seniors are not confident in their ability to afford long-term care or support services versus 25 percent of seniors with incomes over $30,000.
26 percent of seniors planning to age in place say they cannot afford the cost of moving their belongings

Health Policy Takeaways

Meeting the needs of a rapidly growing senior population will require policy decisions that give older Americans the opportunity to age in place. Many of these individuals will require healthcare that extends beyond the capabilities of spouses, friends and loved ones, and many face economic challenges that limit their access to quality care.

Home healthcare patients are among the poorest, sickest and most vulnerable beneficiaries in the Medicare program. Quality home healthcare services allow these patients to remain in their homes and receive necessary skilled nursing and rehabilitative care.

As the most cost effective, clinically skilled setting available, home healthcare can reduce healthcare costs while meeting the needs and desires of a diverse senior population.