Home care payments plummet; MedPAC sets 2000 work plan
By MATTHEW HAY
HHBR Washington Correspondent
BALTIMORE Medicare home health payments fell a staggering 38% from 1997 to 1998, according to new data from the Health Care Financing Adminis tration’s (HCFA; Baltimore) Customer Information System. Total payments decreased from $16.7 billion in 1997 to $10.5 billion in 1998 while visits dropped 40%.
On a per-patient basis, reimbursement decreased from $4,705 to $3,412 from 1997 to 1998. Meanwhile, visits per patient dropped from 73 to 51.
These latest data are the most dramatic evidence to date of the impact of the Balanced Budget Act of 1997 (BBA). Home care representatives are hoping the numbers will help fuel congressional efforts to eliminate the additional 15% across-the-board cut scheduled for Oct. 1, 2000.
Last week, the House Commerce Committee opted not to mark up the BBA reform bill introduced by Commerce Committee Chairman Rep. Tom Bliley (R-VA). Instead, a committee spokesman said Bliley has been promised that his bill will receive equal consideration with the BBA reform bill approved by the House Ways and Means Health Subcommittee.
Meanwhile, the Medicare Payment Advisory Commission (MedPAC; Washington) has developed its work plan for home health for the year ahead. According to MedPAC’s Louisa Buatti, MedPAC has three studies planned. The first is an evaluation of HCFA’s proposed rule for the prospective payment system (PPS) and will include a letter of comment for the Secretary of Health and Human Services.
Buatti noted concern by some MedPAC commissioners regarding "the generalizability" of the demonstration projects that HCFA has conducted. Part of that concern stems from demonstrations conducted before the implementation of the interim payment system (IPS) but that PPS rates will be based on IPS levels, she said.
"Another issue is the ability of the case mix adjuster to predict resource use," according to Buatti, "particularly because there appears to be great variation among home health users."
In addition, she said, the commission expressed interest in the size of the payment unit and the need to develop special payment provisions for very high-cost patients.
Buatti said the second study will compare PPS payment rates for 60-day periods of time with the payments that occurred for 60-day periods of time prior to PPS.
The third study will examine home health use over time, according to Buatti. "This will provide us with baseline information to evaluate the PPS," she explained.
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