HHAs prepare for cuts and changes with health care reform
HHAs prepare for cuts and changes with health care reform
Agency reps make sure legislators have all of the facts
Even before health care reform became a major topic of conversation, home health agencies have been facing a number of changes that affect reimbursement, documentation, staff education, and services. According to experts interviewed by Hospital Home Health, health care reform will only add to home health agency managers' already long list of challenges.
Although no one can predict what will be included in any healthcare reform legislation, the reality is that it will probably include cuts in reimbursement, and these cuts will come on top of a number of cuts experienced in home health already, says Mary Newberry, RN, BSN, president of the Illinois Homecare Council and director of home health and outpatient infusion for Riverside HealthCare in Kankakee, IL. "When the case-mix adjustment was cut, MedPAC [Medicare Payment Advisory Commission] just used data from freestanding home health agencies to develop their recommendation," she says. Because MedPAC based their recommendation on the reported profit margins, which showed a higher profit margin than hospital-based agencies tend to make, the cuts have a serious impact on most hospital-based agencies, she explains.
"I can't speak for the whole home health industry, but I believe, based on my agency's experience, that hospital-based agencies tend to have higher acuity rates," says Greg Solecki, vice president of Henry Ford Home Health Care in Detroit. Depending on circumstances, a hospital-based home care agency may have higher overhead costs, including salaries, which reduce profit margins, in addition to caring for sicker patients, he explains. "I've always questioned the accuracy of MedPAC data, but the reality is that Medicare Advantage programs will mirror Medicare payment policies recommended by MedPAC," he adds.
According to the National Association for Home Care and Hospice (NAHC), almost one-half of the $1.2 trillion that health care reform proposals would cost over a 10-year period would be paid with Medicare cuts. Some of the dollars would come from a freeze on market inflation, and some would come from a 1% reduction in payments every year for a "productivity adjustment." Home health care payment rates would be reset in 2011 after reassessing the amount of money earned by agencies for services and length of time associated with care.
"This will be the first time for this type of change since 1997, when the pay-per-visit payment system was changed to a payment based on type of care," says Tow. "We are asking that if payment cuts are made, to implement them over a period of time, not all at once," he adds. A slower implementation of reimbursement changes will give more agencies a chance to adjust to changing reimbursement, which will reduce the number of home health agencies that might go out of business, he points out.
At the same time that agencies are trying to figure out how to deal with lower reimbursement levels, the general public believes that home health agencies are cheating the health care system. "We are fighting an image that home health is overly profitable," admits Newberry. "Not only do the number of fraud and abuse cases related to home health damage our industry's image, but the number of home health agencies sprouting up add to the impression that this is an extremely profitable business," she says.
Unfortunately for home health managers, the first step in advocating for the industry with legislators is to first address the image, says Newberry. "Although most people believe that home health is a valued and needed service, fraud and abuse is often the first issue we have to discuss," she says. In fact, Newberry was surprised when visiting a legislator's staff person, who was the lead health care person on staff. "The first thing she says is that 'You are going to have to do something about the fraud in your industry,'" she says. "Because she was referring to a case in Florida, we were able to counter her statement with the fact that home health agencies had reported the fraud two years before any action was taken," she adds.
Keep staff up-to-date
Newberry and her key managers are not the only people in the agency who stay informed on legislative issues. "We use flyers, voice mail messages, e-mails, and staff meetings to educate all of our staff members on legislative and regulatory issues that affect the agency," she says. "We think it is important that they hear the information from us, not just from the general media." State and national-level associations offer tools and resources that can help with all educational and advocacy efforts, she suggests.
Showing legislators what you do is an additional step in advocacy that is effective, suggests Brent Tow, president and CEO of Community Health Professionals in Van Wert, OH. "We invite legislators to any community event that we have, and once each year, we invite them to make a home visit with us," he says. Conversations with legislators mean more after they've seen the impact of home health, he adds.
In addition to staying up to date, participating in advocacy efforts of national organizations, and educating staff members, what can home health managers do to prepare for whatever comes with health care reform? "Agencies must diversify their services," recommends Tow. Offering a variety of services and finding the most efficient way to deliver those services is essential for survival, no matter what happens with health care reform, he explains.
With all of the changes being discussed, there is one certainty, says Solecki. "OASIS C [Outcome Assessment Information Set] is effective January 2010," he says. Implementation of the new data collection and assessment tool will have a huge impact on home health agencies, because it does collect different information than the previous OASIS tool, he explains. "We are focusing on staff education for OASIS C to make sure our documentation is as accurate as possible," he says.
Because health care reform proposals recommend reimbursement cuts beginning immediately upon approval, the toughest challenge for home health managers is budgeting. "I'm working on my budget now," says Newberry. Between the wage index cut and the case-mix decreases that are already in place, she is already facing the need to increase volume or increase case mix to improve revenue, she explains. "Managers need to budget conservatively and expect all of the cuts in order to keep their agencies financially viable."
Sources & resources
For more information about health care reform, contact:
Mary Newberry, RN, BSN, Director, Home Health & Outpatient Infusion, Riverside HealthCare, 1905 West Court Street, Kankakee, Illinois 60901. Telephone: (815) 935-3272. Fax: (815) 937-7961. E-mail: [email protected].
Greg Solecki, Vice President, Henry Ford Home Health Care, One Ford Place, 4C, Detroit, MI 48202. Telephone: (313) 874-6500. DO NOT PRINT FAX E-mail: [email protected].
Brent Tow, President and Chief Executive Officer, Community Health Professionals, 1151 Westwood Drive, Van Wert, OH 45891. Telephone: (419) 238-0751. E-mail: [email protected].
National Association for Home Care and Hospice offers a legislative action center that enables visitors to identify their legislators, send an email to them, and to view detailed information that can be used when talking with legislators. Go to www.nahc.com, select "Legislative Issues" on top navigational bar, then scroll down to "Home Care."
Even before health care reform became a major topic of conversation, home health agencies have been facing a number of changes that affect reimbursement, documentation, staff education, and services.Subscribe Now for Access
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