Op-ed: Medicare proposal puts Utah patients at risk

Published by Deseret News
Ed Dieringer and Matt Hansen
September 21, 2017

If you were to ask seniors across Utah where they’d prefer to spend their twilight years, most of them probably wouldn’t respond, “in a hospital bed.” Instead, you would hear how important it is to be in their homes, supported by family and friends. Thanks to the Medicare home health benefit, 3.5 million seniors around the country have the opportunity to remain in the comfort of their own homes while receiving nursing and/or rehabilitation therapy services to help them recover from an illness or injury.

Unfortunately, proposed changes to the way the federal Centers for Medicare & Medicaid Services (CMS) pays home health providers threaten to disrupt access to care for tens of thousands of home health beneficiaries in Utah and millions more across the country. Known as the Home Health Groupings Model (HHGM), this proposed payment reform would be extremely disruptive to Utah home health patients, causing many to lose access to medically necessary and already low-cost health care services, while creating new administrative burdens for home health care providers.

Among its many provisions, HHGM moves toward shortening the typical 60-day home health episode of care to 30 days and places beneficiaries into arbitrary “payment groups” that determine how much Medicare will reimburse providers for care provided to each patient. While the original stated intention of this policy was to control costs and promote efficiency, it will likely do the exact opposite, as providers struggle to keep up with significant rate reductions that result from the rule and new, complicated billing and reporting requirements. Preliminary analysis of this new payment structure shows Utah — especially rural Utah — would be hit particularly hard with unevenly distributed payment changes.

Furthermore, the HHGM would decrease utilization of effective services, such as physical, occupational and speech therapy, that help keep patients out of higher-cost institutional care; penalize providers who invest in performance and risk-based alternative payment models (e.g., Accountable Care Organizations, comprehensive care for joint replacement and other bundled payment models), and cause home health agencies to provide fewer services, sacrifice quality or possibly close due to financial unsustainability.

What’s particularly concerning is the incredible lack of transparency from CMS on the development of the HHGM rule. CMS has stated that researchers were used to inform on the development of the payment model development; providers and patients who receive home health services were not consulted. Despite multiple requests for additional information, CMS has only provided vague details about how the program will operate, complicating providers’ ability to fully evaluate a payment model that would make such sweeping changes to an entire industry.

Fortunately, there is still time for CMS to change course. Through collaboration with outside experts and home health community leaders, a payment model that protects patient care while enabling cost savings and efficiency in the home health sector can still be developed. However, CMS must first withdraw the proposed rule and take time to develop a workable payment model that protects care for Medicare’s most vulnerable patient population.

Over the next few weeks, home health advocates in Utah and across the country will be calling on lawmakers in Congress to urge CMS to do just that. The health care of millions of seniors — many of them friends and family members — is too important to jeopardize through this deeply flawed and poorly thought-out reimbursement policy.

We ask Utah’s senators and congressional representatives to join Utah’s residents and stand up for Utah’s home health community by fighting for withdrawal of the Home Health Groupings Model. Public comment on the rule can be made directly to CMS until Sept. 25, 2017, by visiting and entering the file code CMS-1672-P. You can ask your representatives to request withdrawal of the HHGM rule by going to or by calling their offices directly.

Matt Hansen, PT, DPT, is president of the Utah Association for Home Care (UAHC), which provides education, advocacy and peer support for Utah’s home care industry, our members, patients and their families. Ed Dieringer, PT, is UAHC’s executive director.

Click here to see the original article on the Deseret News website.

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