Patient Access to Home Health Undermined by CMS Cuts
Tuesday, November 26, 2013
by: Visiting Nurse Associations of America

Section: Quality and Educational Programming

VNAA Southeast Regional Meeting Provides Timely Insight

VNAA has put together a terrific agenda of educational sessions for its Southeast Regional Meeting on Dec. 5-6 in High Point, N.C. Educational sessions will include how to approach a financial performance evaluation and target ways to improve, as well as a tutorial covering ICD-10 coding changes that will affect home health and hospice providers.

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Get the Only Clinical Manual Your Agency Needs.

Designed specifically to help multidisciplinary home health and hospice professional teams improve their ability to deliver high-quality and consistent care in one adaptable and comprehensive evidence-based manual, the 18th edition of VNAA's Clinical Procedure Manual is one you won't want to miss.

Order before Dec. 31, 2013 and receive an additional 15% off.

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Follow the Pathway to Best Practices

VNAA introduces a new quality improvement and workforce training resource, the VNAA Blueprint for Excellence. It is a designed to provide information and tools for home health organizations, payers, policymakers, researchers and others with a stake in improving care transitions.

Available at no cost, the VNAA Blueprint includes research- and practice-based tools and training, as well as measurement and evaluation resources to guide home health care practices.

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The Centers for Medicare and Medicaid Services (CMS) will slash funding and reduce services for vulnerable patients to access the Medicare home health benefit, despite substantive arguments from VNAA and other home health industry organizations, patient advocacy groups, providers and a bi-partisan group of over 193 members of Congress. Fifty-one senators and 142 representatives signed on to two letters to CMS raising serious concerns about the home health benefit and its proposed implementation of the rebasing provision.

In a Nov. 22 final rule, CMS cut funding for the Medicare home health benefit by $200 million starting Jan. 1, 2014. While CMS claims that reductions are only 1.05 percent in 2014, the actual base payment reduction for home health care services, or "rebasing," is 3.5 percent annually for 2014-2017. This is a cut that most definitely will curtail access to the benefit. VNAA's policy staff have analyzed the final rule and created a summary of relevant changes available here. VNAA's earlier comments on the proposed ruling, published in August, are available here

"VNAA will continue to fight for the right of vulnerable patients to receive the home healthcare they need. We are extremely disappointed that CMS would so dramatically reduce funding - especially because patients, physicians and hospitals want to increase use of the Medicare home health benefit to avoid institutional care for patients who can have their medical needs met at home," said Tracey Moorhead, president and CEO of VNAA. "We will insist that access to home health care services, including skilled nursing, be closely monitored by CMS.”

Provision of medical care at home is viewed by many experts as critically important in reducing institutional costs for Medicare, Medicaid and private insurance. Although best practices and healthcare trends indicate that many homebound patients can receive effective care at home, only about 3.5 million of the 49 million Medicare beneficiaries are able to access the home health benefit.

CMS cuts in the Medicare home health mean that many homebound patients will lose the option of receiving skilled care at home and be admitted to high cost acute care, institutional settings, which is an outcome that is in direct conflict with the goal of reducing unnecessary care and costs. Cuts will impact elderly and disabled patients with multiple chronic conditions the hardest. VNAA's mission-driven nonprofit agencies serve all who need care but are often the only agencies that take high-cost, low reimbursement patients who may be avoided by other providers.

A physician may order home health only if a Medicare beneficiary is homebound and requires skilled care. The benefit is mostly commonly provided in 60-day episodes but enables many vulnerable patients to avoid hospital or nursing home care.
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