Home Health Groupings Model: The Future of Home Health

In our previous installments of this CareThreads blog series, we examined the Home Health Groupings Model and the reaction it’s currently getting from the home health industry. Today, we’ll get a glimpse of what it means for home health going forward.

The rule modifies the way home health agencies would be reimbursed for care, categorizing patients into six groups based on diagnosis. It also proposes moving from the current 60-day episode of care to 30-days, which is expected to create an estimated cut of nearly $1 billion in reimbursements. There is major concern that this reduction in payments could lead to a critical loss of services to millions of patients across the country.

To address the issue of fewer payments to providers, organizations may need to take steps necessary to balance costs such as providing reduced services, or liquidating facilities in order to make up for lost revenue. Fewer services and/or locations made available to the population certainly cannot be a positive step in the long run for those who are in need of the care that home health agencies provide.

If the proposed HHGM becomes official, it’s going to come down to the types of claims that a home health agency submits. Those providers who have more claims that are dominated by episodes with high therapy, no recent hospital stays, or patients with behavioral health conditions such as schizophrenia, bipolar disorder or drug addiction may see more of a negative impact than those who do not.

Additionally, opponents are apprehensive about the legal ability for CMS to make blueprints that are not budget neutral nor have been tried or tested for success in any other healthcare environment. They do not feel that it is necessary for such a bold plan to go into effect without proper review and exploration.

Beyond that, home healthcare is becoming increasingly frustrated by the continual cuts being proposed by CMS with the last four years accounting for overpayment in previous years.

Although the HHGM would not technically begin until CY 2019, a 0.4 percent decrease is slated for CY 2018 to help get the ball rolling with an $80 million cut in reimbursement for the year. Opponents believe that this may cause major disruptions in the industry even before the HHMG rule goes into effect.

Home health agencies and industry professionals expect to work with each other as well as leverage other experts to work with CMS to reexamine and reshape the HHGM model. It’s important for the industry to communicate the importance of not diverting payments away from therapy services that are typically a major factor in successful outcomes for individuals receiving home health services. Providers will continue to advocate for a home health payment system that will support care providers and patients based upon proven successes, not best estimates.

Regardless of opinion, time is ticking and home health agencies and industry leaders must continue to advocate for their cause or navigate the new plan when it goes into effect for CY 2019. One thing is for sure – they’ll be working tirelessly to ensure that CMS reconsiders their proposal.

Over the upcoming months, we will undoubtedly hear more and more chatter surrounding the HHGM discussion and will be eagerly awaiting the final outcome as both CMS and the home health industry work towards finding a solution that meets the needs of CMS, home health providers and the most important party at the center of it all, the individuals for which they provide care.