Home health providers prepare for 2.2% Medicare pay cut

The Centers for Medicare and Medicaid Services has proposed a 2.2% cut in reimbursements to home health providers in fiscal year 2024 in a draft regulation published Friday.

The proposed rate change is the product of a 3% market basket update, a minus 5.1% adjustment related to the patient-driven group model and other factors.

chief ministers Patient-driven group model introduced in 2020 Instead as a means of reducing unnecessary care by tailoring reimbursement according to patient characteristics. The agency made an assumption that providers would respond by upgrading claims and included a downward reimbursement adjustment for compensation, although by law the payment model must be budget neutral compared to the old system.

An industry trade group said the agency badly miscalculated how providers would adopt the revised reimbursement system and how it determined budget neutrality threatened the viability of home health providers.

“Overall spending on Medicare home health has decreased, fewer patients are receiving care, patient referrals are being declined because providers cannot provide needed care within payment rates, and fewer patients are seeking care to reduce care costs.” providers have closed their doors or restricted service areas. If the rate were truly budget neutral, we would see these actions happening, William Dombey, president of the National Association for Home Care and Hospice, said in a statement. “The fatally flawed budget neutrality method that CMS is pushing to implement will have a direct and lasting impact on access to care.”

Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare, said she fears the cuts will cost the industry about $18 billion over the next decade. “The home health provider community is deeply concerned that CMS’s proposed actions for 2024 will only continue to reduce beneficiary access to home health services,” he said in a statement.

CMS recommended modifications to the home health value-based purchasing program by replacing five existing metrics with a claims-based discharge measure, an outcome and improved discharge function score, and a measure of stay within potentially preventable hospitalizations. also proposed. These changes will take effect in 2025 and CMS projects savings of $3.38 billion by 2027.

The agency will accept comments on the proposed home health potential payment system rule through August 29.

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