VA Eliminates Copayment to Expand Home Health Access

The Department of Veterans Affairs (VA) recently announced plans to remove copayment requirements for in-home video tele-health care in the hopes of making the home a preferred place of care, when medically appropriate for the patient.

The Partnership applauds the decision to eliminate copayment requirements for in-home video tele-health care.

With healthcare costs on the rise, it is important that we do not discourage our veteran populations from seeking cost-effective care options by requiring out-of-pocket payment. By removing the copay requirement, the VA will eliminate a barrier that may have previously discouraged veterans from choosing in-home video tele-health as a viable, cost-effective care option.

Home Based Primary Care: A Model for Reducing Healthcare Costs

Through the Home Based Primary Care (HBPC) program, the VA has provided comprehensive primary care services to veterans in their homes since 1972.

The program has proven to be highly effective in reducing preventable emergency room visits and inpatient hospital days.

The HBPC successfully reduced inpatient hospital days by 62 percent and nursing home days by 88 percent, resulting in a 24 percent decrease in total healthcare costs.

The VA HBPC has been characterized as “a model to emulate for the care of persons with complex, chronic disabling conditions, improving quality without added cost, and maximizing their independence through comprehensive longitudinal interdisciplinary care delivered in their homes.”

We applaud the VA for its leadership in providing quality home healthcare programs and for its latest decision to make home health a more affordable, accessible option for our nation’s veterans.

 

Medicare and Medicaid Fraud: a Targeted Problem in Need of a Targeted Solution

We recently had the opportunity to attend the Alliance for Health Reform briefing on healthcare fraud and prevention. It’s an important and timely topic for the home healthcare community. Our community recognizes that program integrity and payment reforms are needed to strengthen the Medicare and Medicaid programs and secure seniors’ access to quality healthcare services.

How Big is the Problem?

  • “Hundreds of billions of dollars in waste and fraud…” (President Obama speech to Joint Session of Congress, Sept. 9, 2009)
  • “These schemes steal as much as $100 billion a year from Medicare and Medicaid…” (Newt Gingrich and AARP CEO Barry Rand, Orlando Sentinel, Sept. 29, 2010)
  • “…Health care fraud and abuse (is) hundreds of billions per year…” (Harvard Professor Malcolm Sparrow, Senate Judiciary Committee, May 20, 2009)
  • One-third of all health care spending is fraud, waste and avoidable inefficiencies (Institute of Medicine [2011] and Thomson Reuters [2009])
  • Americans think 51 cents of every federal dollar spent is wasted (Gallup, September, 2011)

For additional information on the cost of health care fraud, please click here.

Fraud and Abuse is a Targeted Problem in Need of a Targeted Solution

The Partnership for Quality Home Healthcare is committed to working toward reforms that achieve significant savings and strengthen Medicare program integrity without harming seniors or cost-­efficient providers.

The Medicare Payment Advisory Commission (MedPAC) has identified 25 counties as having the highest prevalence of Medicare abuse in home healthcare:

MedPAC 25

The MedPAC data demonstrate that program integrity is a targeted problem. In response, the home healthcare community has developed bold reforms that offer a targeted solution.

Precedent: Medicare’s 10% Limit on Home Health Outlier Claims

In 2009, the home healthcare community proposed a Medicare reform limiting home healthcare outlier claims to 10% of a provider’s total reimbursement. This policy was adopted and has proven effective in achieving savings without harming seniors or cost-efficient providers.

Analysis of CMS’s recently released claims data for 2010 indicates that the Outlier Limit generated $853 million in savings in 2010 – equivalent to $11 billion in 10 year savings – without harming seniors or the vast majority of cost-effective providers who operate inside the national norms.

Our Proposal to Fight Healthcare Fraud

To fight fraud and strengthen program integrity, while protecting seniors who rely on home healthcare services, we propose payment reforms based on the Outlier Limit model:

  • Episode Limit: cap payment at a per-­provider average of 2.7 episodes per beneficiary (non-­rural) and 3.3 episodes per beneficiary (rural).
  • LUPA Limit: incorporate a minimum annual low utilization payment adjustment (LUPA) rate of 5% to all episodes payments.

To learn more about coordinated efforts to combat healthcare fraud by leading organizations representing America’s senior, disabled, minority and veteran populations, visit http://www.americansagainstfraud.org.