Wednesday, September 27 | Legislative/Policy, Post-Acute Care

Home Health Groupings Model: Industry Reaction

By Dawn Iddings, SVP and Managing Director, Post-Acute

In the first blog of our series, we’ve discussed, at a high-level, upcoming payment changes for CY 2018 and beyond. The biggest, most talked about change is the Home Health Groupings Model, or HHGM.

In a nutshell, the model proposed by Centers for Medicare and Medicaid Services (CMS) would end the impact to reimbursement based on the number of therapy visits. Reimbursement would then be based on newly modified mix of patient and case characteristics, such as episode timing, admission source, certain clinical groups, functional level and comorbidities. The proposed rule would also shorten home health episodes from 60-days to 30-days.

CMS hopes the plan will reduce Medicare home health payments by $950 million, and it insists that it will only help providers by reducing stress, support patient-doctor relationships and improve care delivery. They maintain that the HHGM will not have any significant impact to access or quality of care, but, as a whole, the home health industry disagrees and contends that the proposed plan is HHGM is a significant and negative change from the current model.

The HHGM has largely been received as unwelcome by home health providers across the U.S. Many providers believe that CMS may be overstepping the mark with the plan that, from the provider perspective, will decrease revenue, increase costs and add additional administrative strain, causing tremendous concern and worry for the industry.

Many in the industry are confounded by the idea that CMS is even proposing changes that are not budget neutral, saying it goes against authority given by Congress. Some feel that the plan was not given enough representation from the industry and some may even consider legal action to contest the proposal.

There is also a looming concern that lack of proper consideration and vetting of the complex plan opens up the potential for additional issues beyond less funding. Groups argue that the HHGM recommendations will steer the industry delivery segment in a direction that has been untried and unproven in any healthcare industry. The removal of incentives for agencies to provide more therapy at higher reimbursement rates may open up opportunities for fraud. Others are worried about technical flaws that could create major redistribution issues across markets.

Home health agencies and industry leaders are calling for a more thorough review of details of the model, saying some of the policies and recommended practices in the proposal are proposed without knowing much about the risks and benefits.

Overall, it can be described that the home health industry as a whole is not supportive of the HHGM, but industry organizations and care providers are very much willing to work towards a solution to meet everyone’s needs while causing little, if any, disruption for agencies in all markets across the country as well as the individuals they serve.

A lot can be said for home health’s reaction to the proposed rule. There is a positive note in the willingness for providers and leaders to join voices and open up dialog with CMS, but it’s still unclear how or if the industry can initiate changes with CMS. The frustration felt by the industry is substantial and real and it will be a matter of time to see how their voices impact the future of the industry.

Next time, we’ll wrap up our series and explore what it means for the future of home health. Make sure to join us!

 

Meet the Author

Dawn Iddings · SVP and Managing Director, Post-Acute

From the CareThreads Blog

Enhanced Care Management: Care Coordination for California's Most Vulnerable

Thursday, June 20 | Care Coordination,Human Services,Legislative/Policy,Interoperability

Did you know that half of all Medi-Cal spending goes to members with the highest risk? These individuals have complex needs and generally require treatment across multiple care settings - such as mental health, physical health and substance use. Enhanced Care Management (ECM) is a statewide Medi-Cal benefit that provides case management services for these members, improving outcomes while streamlining costs.

More
Medi-Cal Enhancements and How Netsmart Can Help

California CARE Court: Simplifying the Complex. Serving the Most Vulnerable.

Thursday, May 02 | EHR Solutions and Operations,Interoperability,Legislative/Policy

Recently, the state of California has been making enhancements to Medi-Cal, in order to address issues like mental health, substance use and homelessness for at-risk populations. This blog will focus on CARE Court, a new program that seeks to treat people with severe mental illness within their communities and keep them off the streets. What do you need to know to implement CARE Court? AJ Peterson shares the details.

More
home-health-care

Survey Success: Proactive Strategies for Hospice Survey Preparedness and Response

Thursday, April 18 | EHR Solutions and Operations,Legislative/Policy,Post-Acute Care,Thought Leadership,Value-based Care

Staying up to date with survey processes in hospice care helps you work towards ensuring quality, safety and operational efficiency. The year 2023 brought significant changes to the hospice survey landscape, with implications that resonate into 2024.

More