HCAF Leaders' Op-Ed on Medicare Home Health Published in State Newspaper
Monday, June 24, 2019
Posted by: Kyle Simon
The Sarasota Herald-Tribune published an op-ed by HCAF Executive Director Bobby Lolley and President Denise Bellville on May 30, 2019. In the opinion piece they advocate for the Home Health Payment Innovation Act (H.R.2573), a Medicare home health-related bill sponsored by U.S. Congressman Vern Buchanan (R-Longboat Key) in the House of Representatives. If enacted, H.R.2573 would mitigate significant Medicare payment cuts scheduled to take effect in 2020.
A new federal Medicare payment policy, formally called the Patient-Driven Groupings Model, threatens to interrupt the delivery of home health services for Florida seniors who depend on Medicare. With demographics shifting and more and more seniors entering the Medicare program, bipartisan policies that protect access to low-cost, patient preferred care should be advanced. HCAF applauds Congressman Buchanan for his leadership and support for access to home health for our state’s seniors!
Congressman Buchanan Fights for Home Health
By Bobby Lolley, RN, and Denise Bellville, RN, COS-C
More than 20 percent of Floridians are currently enrolled in the federal Medicare program – meaning upwards of 4 million seniors depend on it for quality healthcare as they age. So there’s no question that protecting Medicare – and the various services that allow aging Floridians to remain healthy and independent – should be at the top of our lawmakers’ priority lists.
Sometimes their well-intentioned efforts miss the mark. Just last year the federal Centers for Medicare & Medicaid Services (CMS) in Washington developed a complicated new payment model for home health services intended to clamp down on fraud and abuse. But that same policy – which would laudably prevent the misuse of Medicare dollars meant for seniors – threatens the ability of home health professionals to provide care for the hundreds of thousands who need it across our state.
Here in Florida, more than 305,000 seniors are enrolled in Medicare home health services that allow a network of nearly 75,000 trained professionals to deliver safe, quality, home-based care. Home health enables aging Floridians to remain safely and comfortably in their homes – where they want to be. It’s the type of care that people prefer, and it is less expensive that residential or institutional care.
So, it’s been extremely troubling that CMS’ new payment structure — called the Patient-Driven Groupings Model (PDGM) — will cut reimbursement rates across the board by 6.42 percent or roughly $1 billion nationally in 2020. These cuts to provider payments will be part of “behavioral adjustments” based on assumptions about what those directing care might do – instead of evidence of how caregivers actually serve Medicare patients. In Florida, it may result in many of our state’s 900 trusted agencies seeing such steep payment cuts that care is compromised.
Fortunately, Congressman Vern Buchanan (FL-16) – a dedicated champion for our senior population – has introduced legislation that would prevent the assumptions model from negatively impacting providers and those for whom they care.
Congressman Buchanan and his bipartisan colleagues in the House have created H.R.2573 as a way to ensure behavioral-based payment adjustments to the Medicare home health benefit are rooted in evidence and actually billing behaviors. If passed, it will require Medicare to implement adjustments to reimbursement rates only after behavioral changes by home health agencies actually occur – instead of assuming billing changes might happen. By requiring the payment model to utilize observed billing changes based on patient characteristics and needs, the bill would ensure a smoother transition to the new payment system, and safeguard Florida’s seniors and caregivers from unnecessary, negative care interruptions.
Safeguarding Medicare for our growing senior population is perhaps among the most critical issues we face as nation – and as a state. But any efforts to do so must not undermine the incredible value of home health delivery.
On behalf of the state’s tens of thousands of home health professionals, we applaud Congressman Buchanan for his thoughtful approach to revising home health payment policies. Our caregivers and, more importantly our patients, are extremely lucky to have him working on our behalf – and for the betterment of Medicare as a whole.
Bobby Lolley, RN, is Executive Director of the Home Care Association of Florida and Denise Bellville, RN, COS-C, is President of Palms Home Care located in Florida’s 16th Congressional District.