The Centers for Medicare and Medicaid Services launched a pilot program that’s known as the Value-based home health care model. It is part of the proposed 2016 Home Health Prospective Payment System that was posted in the Federal Register last July 2015.
According to the CMS, a lot of people want to receive health care from the comfort of their homes. Their goal is to ensure that the care in the home is supported by a value based home health care model that is consistent with CMS’ system. They want to implement a payment system that first slashes payments to HHA’s but then rewards home health care providers that deliver the highest quality results.
The value based home health care model was already implemented in nine states(Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee) as of January 1 of this year. The CMS has released guidelines that governed agencies providing home health care services. The agencies have to compete to get increased Medicare payments as a reward for their better performance. That means it will affect the quality and standard of care that patients will receive, as well as that of participating home health providers. Because of the required adjustment of rates, it will force a lot of agencies to close down.
What did the value based home health care model bring?
Under the program, there will be various quality measures that will be assessed to determine the total performance score of a home health provider. An agency must have at least 20 home health episodes of care for a specific measure. The CMS will not adjust the payments to an agency unless they are able to get scores on five measures and above. The achievement thresholds and benchmarks are available in April 2016 while the claims measure in July 2016.
CMS claims that the changes are in accordance with their strategy to develop a health care system that supports smarter spending, healthier people, and better care. The nation’s health care system will value quality more than quantity, and the changes will result in better services and a more efficiently coordinated system.
While it looks like the value based home health care model will help bring improvement to the system and reward quality, this is not the case in the real world. The Value Based Purchasing will just reduce patients’ access to home care services, as well as payments under the Medicare home health benefits. That’s why consumer groups and health care provider organizations have been stating their objection to the proposed rule since the CMS first announced it late last year.
Under the proposed rules, home health agencies will face financial penalties of up to 8 percent for taking care of patients who don’t show any improvement on their diagnoses or condition. This will affect patients that are suffering from ALS, Multiple Sclerosis, stroke, paralysis, and Alzheimer’s disease, just to name a few. Patients with these conditions are not expected to improve on their diagnoses in the short term, and the home health agency that takes on these patients will suffer financial risk. TheCMS will eliminate potential patients for home health care if they don’t have the ability to improve.
Instead of making home care more accessible to people, the CMS prefers sending them to institutional options. Even if patients want to stay at home, they will be forced to look for alternatives. While improve can be one of the measures of the quality of care, it should not be the only measure. The CMS must also have certain quality guidelines for patients that don’t require improvement. Some examples of patients that require skilled care by a home health agency but don’t require improvement include patients with congestive heart failure; care for non-healing or slow healing wounds; and patients with neuromuscular disease.
The CMS should evaluate its value based home health care model to ensure that it doesn’t leave out certain types of patients. They should not rely only on improvement to identify who requires skilled care at home. Home Health agencies wish that theCMS take the negative out of the value based home health care pilot program, and improve on the positive ones. Those way patients will have better access to the health care that they require.