Home care has reached a critical point, according to Scott Levy, chief government affairs officer for the National Care Alliance for Home (Aliance).
Not only is the pressure on providers unsustainable, it also threatens access to savings from home costs. Already, more than a third of patients referred to at-home health are unable to receive these services.
Home hygiene faces a triple threat by deepening Medicare rate updates that have not kept up to the penetration of patient-driven grouping model (PDGM) payments, real inflation, and improved Medicare advantage (MA).
Meanwhile, home and community-based services are in the crosshairs of the budget adjustment bill passed by Congress and are now in the hands of the Senate. We believe access to care will definitely be affected, but there are still questions about the extent to which it is.
While current policies and regulations have caused “cuttered water” for home care providers, the industry has demonstrated that it can step up and support health care systems during the Covid-19 pandemic.
Home Health News sat at Levi to discuss the policy shift to reshape the home care industry, the real-world impact of declining access to home care services, and what providers should wear to support as key laws move forward.
Below is a conversation edited for length and clarity.
HHCN: What policies or regulations do home-based care providers currently need to monitor?
Collection: Whatever affects access to care, whether from home health, hospice, home and community-based services, or palliative care perspectives, particularly as it relates to payment reforms that may be incurred or to reduced payments that have passed through CMS over the years.
There is some data showing what happens when access is delayed or insufficient access, what it means for the Medicare Trust Fund on the home side, and what it means for patients. That information is important in terms of policy that you will need to go out the next day.
On the hospice side, whether it affects payment or profit, modernization, fraud, waste, abuse, hospice policies, I think the policy debate we have must adhere to the core of the argument that you are the patient and family who have made a very tough decision to prohibit healing cars. Whatever the policy debate we have, we need to make sure there is no interruption to the sacred decisions they have made.
Can I narrow it down to specific policies that may affect access to care?
We will specifically talk about home hygiene. With the implementation of a patient-driven group model on the home health side, which began in 2020, actually in the rules proposed in 2023, CMS began implementing payment reductions to achieve what would be budget neutrality by measuring the old payment model into the new payment model. Every year we have seen profit payment cuts. These payment cuts were happening when we saw generational inflation that was not maintained through annual market basket updates. We also see an increase in penetration of Medicare advantage. So all three affected access to care for home hygiene.
CareJourney's study of patients referred for home care shows the difference between those who have obtained it and those who have not. Less than 63% of people referred to in-home hygiene can actually access it. So access is clearly a problem. It can only be said that home healthcare institutions exist in the postal code, but it is not an appropriate measure for access.
However, for those who don't understand, we know from the CareJourney survey that individuals who do not receive home health services are more likely to be readmitted to the hospital within 90 days of discharge. They are more likely to die in those 90 days if they do not receive home health. Additionally, the increase in hospital spending 90 days later was 6% higher.
It's the perfect example of not measuring the impact of what access to home health care has. So, if there is an inadequate inflation update, plus payment cuts, along with an increase in Medicare advantage penetration, there is a crisis that millions of Americans across the country have no access to household health benefits. If you need a health-conscious health system, you can't continue to cut it down.
What are your top three federal policy priorities now?
Ensuring that hospice benefits are protected from fraudulent providers and maintaining the integrity of Medicare Hospice benefits, ensure access to care is not interrupted, whether Medicare advantages start covering hospice or a massive payment redesign.
In terms of home hygiene, as mentioned before, it is a matter of refunds. Therefore, there is a very healthy advantage for providers to provide Medicare beneficiaries in this country to protect against further reductions on the reimbursement side of Medicare fees. This is a top priority for home hygiene.
Medicaid, home-based services, and community-based services are on the cross of things going on in the settlement bill. We understand that this legislature is moving forward with changes to its state-level Medicaid program through funding. They have not decided how the state will change its program, but they know that it will not only eliminate fraud, waste and abuse, but it will affect Medicaid home and community-based services. So, as it is surrounded by a Senate settlement, it will continue to work with members of Congress for the next few days. The policies finalized in this settlement have the least impact on access to the care of eligible beneficiaries worthy of and community-based services.
If the proposed budget adjustment bill passes in the Senate, what will be the impact on home care?
That's the hard part because home-level and community-based services are all at the state level. Therefore, these are Medicaid programs directives and optional programs for the state's Medicaid programs. How these funding mechanisms addressed in HR1, “big, beautiful bills,” are implemented at the state level, determine the impact on home and community-based services. Whether it's a job requirement or a provider's tax, all of this.
Every time we take away funding for a mandatory program, there will be downstream consequences. They need to figure out how to compensate for that funding, but unfortunately it will be an impacted home and community-based services, as well as other options Medicaid programs. Cutting HCBS funding will show you what will be done to increased wait times and overall spending for the state's Medicaid program. They need care, so they will have to go somewhere to get it.
If there is one thing to say to a home-based care provider, what would it be?
Don't be discouraged. This is a very tested time in the world of policy. It's difficult when changes occur in payments and policies, but we still have very unique opportunities for aging in America and where they want to be. We can go through some challenging times and continue to show value to both the Medicare Trust Fund, as well as the family of patients to which clinicians, operators and providers serve. We can have you talk about why this is such a unique and professional advantage for home health, hospice, home and community-based services, and why you need to do everything you can to protect it. Involving others in that movement will help us do that, but we are not discouraged by the choppy waters we may be swimming at the moment. Because here we have the opportunity to truly shine for the industry.
The home-based care community has really stepped up during Covid and provided a lot of support to the health care system. There is no reason why it should happen in a generational pandemic era. This is something that home and community-based services and the general home care community can do at all times.
