Congressman Lee Terry Meets with 10 NAHCHA Agency Provider Members
By Janet Seelhoff
Ten Nebraska Association of Home and Community Health Agencies (NAHCHA) provider members recently met with Congressman Lee Terry (R-NE) and his legislative staffer Spencer Head at The Visiting Nurse Association of the Midlands in Omaha. Congressman Terry received updates on rebasing of Medicare home health payments, face-to-face requirements, impact of potential Medicaid expansion, and the benefits of reimbursing home health providers who use telemonitoring technology for clients.
Rebasing of Medicare Home Health Services
NAHCHA agency provider members explained the serious impact of Medicare home health cuts that the Centers for Medicare & Medicaid Services (CMS) put into effect on January 1, 2014. These cuts are so immense that they will cause 52.4 percent of home care providers in Nebraska to operate at a loss. That means 38 of Nebraska’s 58 Medicare-certified home health agencies will be under water by 2017.
Rebasing is a requirement of the Affordable Care Act, but home health associations and providers question CMS’ approach and simply ask that CMS postpone these damaging cuts and devote more time to a thoughtful analysis of the data.
Providers told Congressman Terry that home care oversight and regulatory compliance responsibilities have tripled in recent years, making it increasingly difficult for home health agencies to spend the time needed to care for clients. They explained that home health agencies operate on a very slim financial margin and that Medicare hasn’t caught up with the shift in agencies’ needs, services, and costs. The group thanked Congressman Terry for signing on to a recent letter to CMS, asking them to delay implementation of the rule until they carefully review data and consider the actual costs of providing home care.
Face-to-face requirements in particular have increased administrative time — and reduced patient care time. This slows down cash flow, the group told Congressman Terry, as home health agencies spend increasing amounts of time working with physicians to ensure they are writing narratives instead of providing bulleted lists and that they are signing face-to-face forms. So the providers thanked him for signing on a recent face-to-face letter to CMS, asking them to modify the requirement, given that other processes such as filing the 485 form are in place to ensure compliance.
Proposed Medicare Home Health Copays
There has been discussion about requiring copays for Medicare home health patients. Yet patients can’t afford a copay for each home health visit, the providers told Congressman Terry, and agencies can’t afford to cover the cost.
Proposed Medicaid Expansion Impacts on Home Health Clients and Providers
In general, home health providers worry that the proposed Medicaid expansion will continue to mean less reimbursement for home health services to Medicaid clients if there are more enrollees in the health care marketplace. In Nebraska, there are also tremendous concerns about how managed care will work. Managed care organizations (MCOs) reimburse at 50 percent of actual costs for home health services, and MCOs are now cutting home health reimbursement by 40 to 60 percent of actual costs for clients who require multiple daily visits. Parents whose children are Medicaid clients have to make difficult choices about whether to quit their jobs and stay home to help care for their children, or admit their children into institutions which are more expensive and take them away from their homes.
Medicaid may not pay home health providers until six months after they provide care. This is difficult for agencies since they operate on tight margins. Home health agencies are already spending a lot of resources to address claims denials, file appeals, and participate in audits. In some cases, regulators are even coming back to audit how something was adjudicated four to five years ago.
There is less attention paid to the way home health providers cut costs by keeping patients at home, which helps them avoid rehospitalizations and more expensive institutional care. Operating at break-even would allow home health agencies to continue serving patients and meeting their needs in the comfort of their homes.
Benefits of Telemonitoring Use in the Home
Home health providers shared with Congressman Terry that they are no incentives in place for meaningful use of electronic health records and telemonitoring technology in the home. The Visiting Nurse Association of the Midlands is telemonitoring more than 2,000 people in the Omaha area, but is eating the costs of the technology. So it supports the Fostering Independence Through Technology Act of 2011 (FITT), which would expand use of telehealth under Medicare to reduce hospital re-admissions in rural and underserved communities nationwide. The providers informed Congressman Terry about FITT and asked him to consider sponsoring this legislation in the House.
Home health providers explained that hospitals are being penalized for re-rehospitalizations. Home health agencies can help by telemonitoring patients’ vitals after hospital discharge but need reimbursement to do so. After hearing this, Congressman Terry requested a breakdown of the costs for telemonitoring services.
There was also discussion about home health providers delivering care and assisting with social service needs, activities that go hand-in-hand. For example, home health agencies provide care for infants sent home after receiving care in a neonatal intensive care unit at the hospital. Home health agencies help ensure these infants receive adequate nutrition and maintain a healthy weight. Physicians count on home health agencies to partner with them as they provide these critical services. And home health agencies count on adequate reimbursement so they can keep infants out of hospitals and emergency rooms, providers told Congressman Terry. He said he wanted to work on these issues and have his staff follow up.
Following the meeting, Congressman Terry visited the home of Kenneth Kulhanek, a home health client of The Visiting Nurse Association of the Midlands. Mr. Kulhanek has cardiopulmonary disease, which he keeps under control with help from home health care. Michele Wakefield, a nurse with the VNA, showed Congressman Terry how Mr. Kulhanek uses a telemonitoring device that asks him to record his weight, fluid levels, and other vital signs every day. If the device detects any changes, Mr. Kulhanek receives a phone call from the home health agency, asking him questions to determine the cause of the changes and he also receives visits from a home health nurse. They’re all services that have kept him out of the hospital since he became a client of the VNA.
About the Author: Janet Seelhoff, CAE, is executive director of Nebraska Association of Home and Community Health Agencies (NAHCHA). She can be reached at Seelhoff@AssocOffice.net.