The House Ways and Means Subcommittee on Health last week held the fourth in a series of hearings devoted to bipartisan proposals to reform Medicare and Social Security, according to the Subcommittee Chairman Kevin Brady (R-TX). The hearing was particularly important to the home care community as its focus was post-acute care payments. The hearings witnesses were Jonathan Blum, Deputy Administrator and Director, Center of Medicare, Centers for Medicare and Medicaid Services and; Mark Miller, Executive Director, Medicare Payment Advisory Commission.
The National Association of Home Care & Hospice (NAHC) submitted testimony for inclusion in the hearings official record. In its testimony, submitted by NAHC Board Chair Andrea Devoti, NAHC emphasized that:
Many studies have found that home health care can prevent expensive hospitalizations and nursing home stays while providing cost effective care in the home setting that people prefer We have grave concerns about the impact of further cuts to home health care payments on access to care and want to ensure that efforts to bundle payments to post-acute care providers recognize the central role that home health should play.
NAHCs testimony also elaborates on several proposals that the organization believes could find bipartisan support on ways to reform post-acute care payments within Medicare, specifically ensuring that Medicare home health payments are adequate to protect access to care and ensuring home health care participation in transitions in care, Accountable Care Organizations, chronic care management programs, health information exchanges and other healthcare delivery reforms.
One proposal that is gaining bipartisan support - and was mentioned by Chairman Brady is an effort to further cut payments by 1.1 percent over the next ten years, which NAHC opposes and in its testimony emphasized that:
The Presidents FY 2014 budget proposal to cut payments another 1.1 percent over the next ten years would further threaten access to home health care. Moreover, it ignores rebasing scheduled to begin next year, which will likely cut home health rates to the bone. More payment cuts on top of rebasing would devastate access to care.
During the hearing, much of the discussion focused on supposed waste, fraud and abuse in post-acute care and profit margins for post-acute care providers with little substantial conversation on actual reform proposals. With respect to waste, fraud and abuse, many members of the Subcommittee and NAHC allies reiterated studies that found such practices were highly isolated to select counties. With respect to the question of profit margins, NAHCs testimony offered data suggesting that a large percentage of home health agencies are at risk of closing because Medicare payments are less than the actual cost of care.
In his opening remarks, Chairman Brady indicated that, after hospital care is in "desperate need for reform" while Ranking Member McDermott emphasized that, we agree on the need for post-acute reform, though he also stressed that everybody wants the best care for their loved ones who are in post-acute settings.
NAHC also reiterated that the organization agree[s] with the Chairman and Ranking Member that we should find the right reforms in post-acute care that can both improve care for todays seniors and extend the fiscal viability of the program well into the future.
The real debate now becomes what post-acute reforms may look like in their breadth, depth and scope. To that end, NAHC and other stakeholders have recently been invited to offer their input into Medicare post-acute payments with members of the House Ways and Means and Senate Finance Committees. Additional information will be provided in an upcoming issue of NAHC Report.
To read NAHCs full testimony, please click here.
For more information on the recent Ways and Means Health Subcommittee hearing, please click here.