National home care associations to hammer out their PPS strategy
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON The five national home care associations last week met with senior officials from the Health Care Financing Administration (HCFA; Baltimore) who are charged with drafting the final home health prospective payment system (PPS). Home care representatives present at the Feb. 16 meeting report that HCFA is examining several options of dealing with potential cash flow problems and may even yield on the proposed 50%-50% split payment included in the proposed rule for PPS.
"It was a good meeting," said American Federation of Home Care Providers (AFHCP; Washington) Ann Howard. "HCFA certainly listened, and I am pleased they appear willing to do what they can under the budget caps that we appear to be stuck with."
But Howard quickly added that she is extremely concerned about access problems for certain categories of patients, such as wound care patients, daily diabetics, and rural patients. She said Tom Hoyer, director of HCFA’s Office of Chronic Care Policy, said the agency will not shift money from one group of patients to another to address these shortages in care.
"That says to me that we are not going to have a solution to the problems facing certain groups of patients at risk under this system," she asserted. "If we don’t, we are going to have a lot of people disenfranchised from the home health benefit."
Howard also reported that HCFA officials eliminated any hope that periodic interim payment (PIP) system will be resurrected in the final rule. But she said the agency is considering changes to the low utilization payment (LUPA) included in the proposed rule. However, agency officials argued that eliminating LUPA entirely would have the effect of lowering reimbursement for all of the case mix categories.
The meeting represented the first opportunity the five groups had to press their case for changes in the agency’s proposed PPS regulation published last November. AFHCP was joined at the meeting by representatives from the National Association for Home Care (Washington), the Home Care Association of America (Jacksonville, FL), the Visiting Nurses Association of America (Boston), and the American Association for Homecare (Alexandria, VA). Also present were representatives from the American Hospital Association (Washington) and the American Association for Homes and Services for the Aging (Washington).
The seven groups had met a week earlier to hammer out a consensus. The groups identified eight areas of mutual concern: transition to PPS, cash flow issues, physician certification of the case mix placement, case mix adjuster, LUPAs, episode gaps, reimbursement for medical supplies, and outliers.
The associations also agreed to urge Congress to pump additional funds into the Medicare home health benefit. Under PPS, home health spending will be budget neutral, which means it can not exceed what expenditures would have been under the interim payment system.
Unfortunately for the home care industry, the administration’s latest budget figures show a steep and unanticipated decline in that spending. In FY99, total Medicare home health outlays were pegged at $9.5 billion, roughly half the $18.4 billion that was originally projected. Remarkably, instead of rising 24% as projected, home health outlays dropped nearly 36%.
Those figures fueled fears that reimbursement under PPS would be less than originally anticipated. "That could in fact happen," said Howard. But she added that agency officials report that they have new data that show that the number of episodes has declined. "That means the two factors could balance each other out," said Howard. "The reduced expenditure levels that put a cap on PPS spending would be offset by the lower number of episodes anticipated in the first year."
If nothing else changes and HCFA sticks to its original prediction of 8.9 million episodes in the first year of PPS, the budget neutrality factor would plummet. But she added that even if HCFA thought that episodes were going to remain at the same level, it would be difficult to let the budget neutrality factor drop further. "Congress did not eliminate the additional 15% cut just to have home health cut," she argued. "It would be a very bad political move on the part of HCFA if they did not find a way to prevent further cuts from home health."
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