Lawmakers are urging the Obama Administration to halt a pilot program requiring prior authorization for home health care services in several states.
In a letter addressed to Health and Human Services Secretary Sylvia Burwell and CMS Acting Administrator Andy Slavitt, Reps. Tom Price (R-Ga.) and Jim McGovern (D-Mass) wrote that delaying patient care while waiting for CMS to authorize home health services would jeopardize patient health and would keep people in the hospital longer, incurring higher costs. The letter was signed by a bipartisan group of 116 lawmakers in the U.S. House of Representatives.
“Many patients find themselves in the most clinically fragile condition during the week following a hospital discharge,” the lawmakers wrote. “It is vitally important that we continue to meet the care needs of Medicare patients during this critical transition time post-hospital discharge.”
Keith Myers, chairman of the Partnership for Quality Home Healthcare and chairman and CEO of LHC Group, said in a statement: “We recognize the intent of the proposal is to combat fraud and abuse within the home healthcare community, but instead of penalizing patients, taxpayers and providers, we ask that CMS work with us to develop program integrity solutions that are patient centered and eliminate bad actors without disrupting access to care and increasing healthcare costs.”
CMS issued its proposal in February as a demonstration project to crack down on fraud and abuse. Five states would be affected: Florida, Texas, Illinois, Michigan and Massachusetts.
Our Take: Mr. Myers—and the congressmen who signed the letter—couldn’t be more right. Such a proposal will result in increased administrative costs and will take the decision out of the hands of the people best equipped to make the call whether a patient requires home health care.
In recent years, CMS has taken great strides by keeping costs under control and improving the healthcare of Medicare beneficiaries through the Innovation Center and accountable care initiatives. This proposed demonstration is a serious and costly step in the wrong direction.
A better idea? Eliminate anti-referral laws preventing hospitals from recommending a home health care company to patients leaving the hospital. Today, patients are presented with a list of home care providers from which to choose prior to discharge. The nurse, or the hospital administrator, can’t choose the best provider to deliver the care.
In a recent nationwide study we conducted with a representative sample of 517 U.S. consumers, we provided respondents with a list of large home health, infusion and private duty companies and asked them to mark which they were aware of. Six in ten couldn’t recognize a single one. Kindred far outpaced their counterparts, with 14 percent name recognition. This was true despite the fact that 53% of our respondents had a recent experience (defined as themselves or a loved one) with home health care.
If consumers have such low awareness of home health providers, why not let the hospital have more say in helping the patient make an informed choice?
If I am a home health provider, and my results are demonstrably better than my competition, the hospitals and physicians I work with will know this and should be allowed to channel business my way. In the spirit of accountable care and the Triple Aim, why shouldn’t I be rewarded by getting the lion’s share of the business?
ACOs have received waivers to the Stark laws since the beginning, and for good reason. They want to encourage collaboration and care coordination, and the only way to achieve that is by having close relationships in tight networks. CMS should empower hospitals and providers to similarly lock in relationships with post-acute providers, beyond the narrow universe of Next Generation ACOs. We believe this will lead to better outcomes, lower costs, and happier patients and the families who support them.