News Briefs
MedPAC: Cut rural add-on, keep 15% cut
New recommendations made by the Medicare Payment Advisory Commission (MedPAC) Jan. 16 contradict the unanimous vote made one year ago, which proposed that Congress implement a two-year extension of the 10% rural add-on to the Medicare home health benefit, provide a full marketbasket update, and eliminate the 15% cut.
Because Congress failed to pass legislation during the 107th session that would enact any of these recommendations in 2002, MedPAC’s 2003 recommendations now jeopardize any remaining chances for home health to have a period of stability, according to representatives of the American Association for Homecare (AAHomecare) in Alexandria, VA.
During its Jan. 16 meeting, MedPAC officials adjusted their recommendation so that only a one-year extension be made to the rural add-on, that it be 5% and not 10%, and that the marketbasket update to payment rates for fiscal year 2004 be eliminated.
These cuts, which would come on top of the 15% reimbursement reduction and a 1.1% cut to the marketbasket update [implemented Oct. 1, 2002, by the Balanced Budget Act of 1997 (BBA ’97)], further would limit access to home health for many Medicare beneficiaries and cause greater instability within the industry.
According to 2002 AAHomecare-funded report developed by the North Wales, PA-based Polisher Research Institute, Impact of Further Payment Reduc-tion in the Medicare Home Health Benefit, approximately 1 million Medicare beneficiaries have been eliminated from the home health benefit since the initial cuts were imposed in 1997. Further, the report also shows that the volume of participating providers has been cut by 40%.
"The fact that we are still learning about the effects of the Oct. 1, 2002, cut to home health providers, and that final cost reports under the home health [prospective payment system] are still not available, underscores the fact that MedPAC is not making sound, informed decisions," stated AAHomecare’s President and CEO Tom Connaughton.
"If further cuts are made to the home health benefit, it will be the sickest and neediest of the beneficiaries who will suffer, as they are also the costliest," he added. "More than any other benefit, home health needs a period of stability to recover from the damage created by BBA ’97.
"Somehow, policy-makers need to learn that home care is a solution to many of the problems we will face as the baby boomers age. We should be expanding benefits for home care — not taking steps to undermine it," Connaughton said.
JCAHO changes ORYX home care requirements
Home health agencies no longer need to submit ORYX performance-measurement data to the Joint Commission on Accreditation of Healthcare Organizations or participate with a listed performance-measurement system.
Medicare-certified home heath agencies can choose one of the two following options:
• Share Outcome and Assessment Information Set (OASIS)-based quality indicator and quality measure data and reports with surveyors, and discuss their relationship to performance-improvement activities. This option does not require agencies to submit data to the Joint Commission and uses the same data to satisfy both federal performance data reporting requirements and ORYX requirements.
• Continue to participate with a performance-measurement system and submit monthly data to the Joint Commission on six performance measures.
Non-Medicare-certified agencies have the following options:
• Discontinue submission of ORYX performance-measurement data through a listed performance measurement system. If the home care organization selects this option, it will need to identify six performance measures from the universe of measures, collect data internally, and generate either run charts or control charts on each measure at least quarterly for use in internal quality improvement activities. No data are required to be submitted to the Joint Commission, but data reports will need to be available for review by surveyors during on-site surveys and produced upon request. At the time of survey, the organization will need to discuss how the data were used in identifying priorities for performance improvement activities.
• Participate in a listed performance-measurement system and submit aggregate monthly data to Joint Commission on six performance measures.
The new requirements will remain in effect until both the Joint Commission and the Centers for Medicare & Medicaid Services establish core performance measures for home health agencies.
More deaths from flu than previously thought
The Centers for Disease Control and Prevention (CDC) in Atlanta has released data indicating that an average of 36,000 people die from influenza-related complications each year in the United States.
This represents an increase compared to previous estimates of 20,000. The findings note that about 11,000 people die each year from respiratory syncytial virus, a virus that causes upper- and lower-respiratory-tract infections in children and older adults.1
CDC researchers say the increase in deaths can be explained in part by the aging of the U.S. population, and the most virulent of influenza viruses in recent years has been the most common strain circulating during the past decade.
CDC director Julie Gerberding, MD, says the new findings indicate that the magnitude of the problem is larger than once thought, adding that officials must stress the importance of high-risk people getting their flu shots every year.
Reference
1. Thompson WW, Shay DK, Weintraub E, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003; 289:179-186.
Cost of care for the aging may be lower
Research in this month’s edition of The Journal of Gerontology showed aging baby boomers won’t run up health care costs as they reach their 80s and 90s by as much as experts forecasted.1
The researchers found that medical costs for seniors who died relatively young were considerably higher near the end, than the costs for people who died at age 85 and older. The research, sponsored by the National Institute on Aging, came from a detailed analysis of 25,954 elderly people enrolled in Medicare between 1982 and 1998.
The average monthly health care expenditure per person in the group was $720 in 1998 dollars, of which Medicare paid $429. Among those who died, the cost was about $3,170 monthly, while those who survived incurred about $590 a month in health expenses. In the month before death, the cost for people ages 65 to 74 averaged about $7,580, while the cost for those 85 and older was $5,254.
Reference
1. Yang Z, Norton EC, Stearns S. Longevity and health care expenditures: The real reasons older people spend more. J Gerontol B Psychol Sci Soc Sci 2003; 58:S2-S10.
MedPAC: Cut rural add-on, keep 15% cut; JCAHO changes ORYX home care requirements; More deaths from flu than previously thought;Cost of care for the aging may be lower.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content