Home Care Issues Front and Center at House Ways and Means hearing
September 8, 2016 03:01 PM
Watch the Video: Rep. Tom Price discusses NAHC priorities during House Ways & Means subcommittee hearing.
A September 7th House Ways and Means Health subcommittee hearingon the evolution of quality in Medicare Part A featured an interesting series of questions and answers between Rep. Tom Price (R-GA-6) and Steve Guenthner, President of Almost Family, a home health care company with over 250 locations in 15 states. Price specifically mentioned three issues important to NAHC and its members, pre-claim review (PCR), the physician face-to-face encounter rule and withholding amounts in the value-based purchasing model.
Rep. Price opened his comments by drawing attention to the May 25, 2016 letter, signed by 116 bipartisan members of Congress, calling for the withdrawalof the proposed use of prior authorization for all home health claims in five targeted states.
“At one point, Medicare officials recommended that home health agencies fax in documents, as the electronic system was not working,” said Price. “Home health providers are experiencing submission issues that require more than 45 minutes for each and every pre-claim review request. Pre-claim rejection rates of between 70 and 80 percent.” Price noted the proliferation of complaints about confusion created by burdensome paperwork requirements.
“Would we be aided by a delay in this demonstration so CMS can get their act together?” Price asked Guenthner.
“Yes, sir, I believe we would,” replied Guenthner. “This PCR, or pre-claim review, topic is a direct result of the physician face-to-face requirement that included a subjective narrative that the home care industry, Almost Family included, commented to CMS would likely result in very high audit error rates because the auditor – 18 months to two years after the fact – would subjectively review the narrative written by the physician solely on the basis of the face-to-face document, not on the bases of the entire medical record.”
Price asked what could be done to improve the face-to-face regulation, prompting this calm, but firm reply from Guenthner.
“We would like to see it much more prescriptive, we would like to see it much easier for physicians to execute and what we have here is a trust problem. When the physician certifies the need for home care, they’ve certified that they’ve seen the patient. The only reason to have them write a narrative that could be challenged later is because we don’t trust the physician’s certification.”
Congressman Price then moved to the Medicare appeals backlog, noting that some claims “have been going on for four, five years, in spite of the 90-day requirement under the statute.” Price asked if the home health community would benefit from a global appeals settlement, similar to the ones used for hospitals, prompting a swift affirmative reply from Guenthner. “Yes, sir. Emphatically so.”
Finally, Congressman Price addressed withholding in value-based purchasing, noting that the withhold percent for hospitals was one percent growing to two percent of a number of years. The proposal for post-acute care, however, is a three percent to eight percent withhold, which Price found questionable.
“When I speak to the folks trying to help patients back home and providing the care in the home health arena, they tell me that in many cases their margin isn’t eight percent,” said Price, who went on to wonder if it would be more appropriate to have a withhold amount equivalent to the hospital community.
“Yes, sir,” affirmed Guenthner. “We do think parity is important across provider groups and that the amount at risk should not get out in front of the infrastructure and the information available necessary for providers to execute. If we get too much at risk we have, we have too high a risk of an adverse outcome or an unanticipated event.”
NAHC has worked extensively with Congressman Price’s office on these issues and will continue advocating for much needed regulatory relief and changes to the value-based purchasing legislation. (More information here)