Congress enacts modest IPS reform
News From Home Care
Congress enacts modest IPS reform
Shortly before adjourning, the U.S. Congress approved a $1.7 billion home health "compromise agreement" aimed at fixing problems for providers created by the home health Interim Payment System (IPS), enacted with the 1997 Balanced Budget Act (BBA). However, the solutions are modest at best, postponing for a few months the predicted crisis in home health care. The industry will be paying for its own relief with future reimbursement cuts.
Susan Schulmerich, RN, MS, MBA, executive director of Montefiore Medical Center Home Health Agency in Bronx, NY, expresses the frustration of many industry leaders over the final version of IPS reform. "To me, it is unconscionable what the legislative and executive branches of the government are doing to home care patients and providers. The delays and posturing have kept the industry on tenterhooks for months," she asserts.
"At the eleventh hour, legislative language was still being crafted to ostensibly right the wrongs’ of the Balanced Budget Act. The frustration and fear of so many in the home care community is that the fix’ will be temporary at best. We [providers] envision 1999 as a replay of 1998, another year of time and money, both in dwindling supply and in trying to obtain meaningful reform of IPS and the BBA."
The final home health provisions in the spending bill include changes in IPS-mandated per-visit and per-beneficiary limits and a one-year delay in the 15% across-the-board home health reimbursement cut that had been slated for Oct. 1, 1999. There will be no change in per-beneficiary limits for "old" home health agencies. Old agencies are defined as those with cost reports filed for fiscal year 1994 above the national median per-beneficiary limit imposed by IPS. However, such agencies at or below the national median will have per-visit cost limits calculated at 66.6% plus 33.3% of the national median.
Fewer patient visits
For home health agencies opening between Oct. 1, 1994 and Oct. 1, 1998, payments are changed to 100% of the national median. Agencies opening after Oct. 1, 1998, will receive 75% of the national median minus 2%. Even though the per-visit cost limit has been increased from 105% of the median to 106%, the per-beneficiary limit remains the same as calculated in the BBA. That will mean fewer visits to patients, predicts Schulmerich.
This modest reform was all the industry could muster, despite the extensive pro-home care rhetoric delivered at a National Association for Home Care-sponsored National Save Home Care Day, held Sept. 10 on the steps of the Capitol. At the rally, members of Congress affirmed the need to reform IPS in order to save home care.Industry leaders say the actual reforms passed this year will stave off disaster only for a few months. An estimated 1,400 home health agencies have already closed their doors during the IPS crisis, and this number could reach 2,000.
Given the limited relief doled out this year, it appears clear that the home care industry must continue to press for reform with the new Congress, Schulmerich says. She intends to fight to protect the future of "an industry that is being chaotically dismantled as each day passes," and she urges colleagues to press their members of Congress for meaningful reform.
"It helps everybody to a certain extent, and it didn’t create a new group of losers," Ann Howard, executive director of the Silver Spring, MD-based American Federation of Home Health Agencies, says of IPS reform. "But we, the disaster victims, are paying for the disaster relief. The other thing is that this whole exercise was all about providers. It had nothing to do with beneficiaries," or with the government’s seeming attempt to cut coverage for long-term, medically complex home care patients.
"The problems need to be addressed very quickly. Otherwise, providers will be closing right and left. They were hanging on by their fingernails, looking to Congress. Many will feel they can hang on no longer," Howard says. "The next step for the industry, I believe, is that we need to focus on rationality and fairness for new agencies and to restore access for patients — two extraordinarily difficult tasks. It would also help if we could get the industry unified."
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