Home Healthcare Leaders Commend MedPAC for Focusing on Program Integrity Reform within Medicare's Home Health Benefit

November 5, 2012
Contact: Emily White

Home Healthcare Leaders Commend MedPAC for Focusing on Program Integrity Reform within Medicare's Home Health Benefit

MedPAC recommendations consistent with home health program integrity proposal

WASHINGTON — At a recent meeting of the Medicare Payment Advisory Commission (MedPAC), commissioners engaged in a meaningful discussion on program integrity reforms that can strengthen the Medicare home health benefit and reduce avoidable hospital admissions and readmissions that may be related to aberrant behaviors. The Partnership for Quality Home Healthcare today commended the commission's attention to this issue and stressed the importance of program integrity reforms.

The home healthcare community has been working for more than a year to develop policy solutions to strengthen the Medicare skilled home healthcare benefit and generate billions in Medicare savings. The home health proposal — known as the Skilled Home Healthcare Integrity and Program Savings (SHHIPS) Act — calls for targeted reforms to protect Medicare beneficiaries, cost-effective providers, and American taxpayers by preventing fraud and abuse before it occurs.

MedPAC further discussed trends in hospitalizations from home health and outlined principles for reducing hospitalizations. Data was presented illustrating that the highest levels of hospital admissions and readmissions from home health are, like abusive billing practices, occurring in isolated pockets of the country. The SHHIPS proposal is specifically designed to target such isolated problems.

The targeted approach recommended by the home health community has already proven successful. A 2009 policy capping Medicare outlier claims at 10 percent, which was adopted by the Centers for Medicare and Medicaid Services (CMS) and included in the Affordable Care Act (ACA), is on track to generate a total of $11 billion in taxpayer savings over the next decade.

"We appreciate MedPAC's attention to this critical issue and strongly believe program integrity reforms are the right approach to target fraud and abuse, strengthen the Medicare home health benefit, and safeguard beneficiaries and taxpayers alike," said Eric Berger, CEO of the Partnership for Quality Home Healthcare. "We commend MedPAC for their extensive work and are grateful for their consideration of reforms that are consistent with provisions of the SHHIPS proposal."

In order to reduce hospitalization rates for Medicare beneficiaries receiving home health, MedPAC explored mechanisms to curb hospitalizations through a penalty program, designed to encourage quality care and ensure program integrity. The Partnership noted the SHHIPS proposal also includes specific previsions to reduce avoidable hospital stays and achieve savings for the Medicare program through a Skilled Home Health Care Hospital Admissions and Readmissions Reduction Program.

Skilled home healthcare is clinically advanced, cost-effective and patient preferred. Nationwide, nearly 3.5 million Medicare beneficiaries receive skilled home healthcare services to treat illnesses related to acute, chronic or rehabilitative needs.


The Partnership for Quality Home Healthcare was established in 2010 to assist government officials in ensuring access to quality home health services for all Americans. Representing more than 1,500 community- and hospital-based home healthcare agencies nationwide, the Partnership is dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation's seniors. To learn more, visit

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