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.
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.
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.
A recent report by the Center for Medicare & Medicaid Services (CMS) revealed what we’ve known for over 20 years – home-based care for the highest utilizers of Medicare services delivers quality care at a lower cost.
Yesterday CMS announced that a demonstration program to increase in-home primary care for patients with chronic conditions resulted in $25 million in savings for Medicare in its first year of a three-year study. The program seeks to determine the value of home-based primary care for frail seniors with multiple chronic illnesses by avoiding pricier hospital and emergency room care.
CMS found that the overall savings achieved averaged around $3,070 per beneficiary. Patients also experienced fewer hospital readmissions within 30 days and used hospital emergency departments less frequently for conditions such as diabetes, high blood pressure, and pneumonia.
This report is the latest of illustrate the clinical and fiscal value of home healthcare for Medicare’s sickest patients:
Programs such as Medicare’s Independence at Home demonstration project will continue to confirm what home health advocates, providers and their patients already know: home health provides cost effective, clinically advanced, and patient preferred care.
The Alliance for Home Health Quality and Innovation has worked with Avalere to release an updated Home Health Chartbook, providing a broad overview of home health patients, the home health workforce, organizational trends, and the economic contribution of home health agencies.
The updated analysis of America’s home health population and industry highlights a number of positive trends with regards to both quality and patient outcomes since the 2013 data was released.
The study revealed that in the past year patients got markedly better at walking or moving around and had less pain when doing so. Patients also experienced improved breathing and were better able to both bathe and take drugs correctly.
In addition to elevated patient outcomes, home health teams met superior quality measures more frequently. Indeed, a staggering 99% of providers met quality standards for checking patients for the risk of developing pressure bedsores. Moreover, 98% achieved high standards for monitoring a patients’ risk of falling.
Across the board, Americans benefited from improvements to the delivery of high quality home health care. Amazingly, home healthcare already allows millions of seniors to receive highly effective care in a patient’s preferred setting – their own home. Now, it is only getting better.
We will continue to fight for Americans already reaping the benefits of home health, and ensure that there is only more good news to come.
On Veterans Day, it is important that Americans everywhere pause and consider the great sacrifice of our nation’s servicemen and women. Even against great odds, they have defended our way of life with valor and steadfast devotion.
Yet, veterans deserve our unbridled support for much more than a single day. And that begins with ensuring our nation’s heroes access to quality, cost-efficient, and dignified care – especially as they grow older.
The U.S. Department of Veterans Affairs (VA) established the Home Based Primary Care (HBPC) program in 1972 to provide comprehensive primary care services to veterans in their homes.
HPBC has significantly reduced preventable emergency room visits and inpatient hospital days for veterans, resulting in a 24 percent decrease in total healthcare costs. The VA expanded access to home healthcare earlier this year through the establishment of the Caregiver Support Program, engaging Caregiver Support Coordinators to assist family caregivers of veterans and providing services to aid in caring for their loved ones
Home healthcare has clearly become one of the single most important aspects of care for veterans. And while there is no way to fully repay the debt we owe to those who served our country, we can continue to give back by providing necessary care in the best possible setting.
Indeed, every day is Veteran’s Day in the home health community, as we dedicate ourselves to improving the lives of those who defended ours.
This week, the Institute of Medicine (IOM) and National Research Council hosted the Future of Home Health Care Workshop, sponsored by the Alliance for Home Health Quality and Innovation (AHHQI), to discuss the current state of home health in the nation’s health care delivery system in order to improve the understanding of the role home health care will play in the future.
As a member of AHHQI, we were pleased to see experts representing academia, think tanks, government, accrediting bodies, healthcare delivery systems, national associations and other thought leaders in the health care community examine trends affecting Medicare home health care today and the changes needed in home health care to optimally serve patients and the U.S. health care system in the future.
You can see a recap of the #FutureofHH conversation on Twitter here.
The Future of Home Health Workshop was one piece of the four-phase Future of Home Health Project. We look forward to learning more in the next phase of the project at the symposium this January.
A study conducted by MedStar Washington Hospital Center found that home-based primary care incurred 17 percent lower overall Medicare costs over a course of two years.
The report published in the Journal of American Geriatrics Society found patients who received home-based care had:
- 10 percent fewer ER visits,
- 9 percent fewer hospitalizations, and
- 27 percent fewer stays in a nursing home.
The study comes at an interesting time, when the Centers for Medicare and Medicaid Services recently imposed cuts of 14 percent on the Medicare home health benefit as a result of the Affordable Care Act.
The results add confusion to an already unprecedented, value-blind decision to cut cost-effective programs for our country’s most vulnerable patients – and it lends serious weight to objections to these cuts.
Eric De Jonge, MD, co-founder of the Medical House Call program at MedStar Washington Hospital Center, discussed the study in more detail in the video below:
Forty-nine years ago today, the Medicare program was established.
For nearly half a century, Medicare has provided access to quality, comprehensive healthcare to Americans 65 and older without fear of bankruptcy.
Today, home health is one of the most important benefits included in the Medicare program, providing care to 3.5 million of the poorest, sickest, and most vulnerable beneficiaries in the country.
However, rebasing cuts from the Center for Medicare and Medicaid Services (as a result of the Affordable Care Act), threaten the future of home healthcare services.
As we reflect on 49 years of progress, we must remember to protect Medicare for the Medicare senior populations of today and tomorrow.
You can help to protect Medicare and the home health benefit by asking your lawmaker to support the SAVE Medicare Home Health Act and by sending a letter to your local paper to remind others how important this Medicare benefit is for senior and disabled Americans!
While all Medicare beneficiaries are in need of healthcare services, home healthcare beneficiaries are typically more vulnerable than the average Medicare patient. They are older, more likely to live alone, have fewer financial resources, and suffer from more chronic health conditions.
In recent years, the home health benefit has been repeatedly hit with spending cuts, which have the potential to directly impact the services offered to some of the most vulnerable of Medicare recipients.
The Partnership is committed to developing innovative reforms to improve and protect home healthcare for all our nation’s seniors.
The infographic below explains the differences between Medicare home health beneficiaries and the average Medicare beneficiary.