In Part I of our series, we briefly explored the home health landscape and featured the top challenges that test providers. Joy Cameron from ElevatingHOME lent some helpful information regarding value-based payment models in home health. Today, we resume our eight-part series, hearing from experienced home health professionals as they offer up valuable advice and insight into the direction of the industry for 2018.

Be Prepared for the Next Chapter of CMS’s Bridge Too Far

In the World War II movie, “A Bridge Too Far”, the Allies, in 1944, tried to leapfrog the German positions in the Netherlands by the means of an airborne assault against several bridges and hold them until reinforcements could arrive. Holding the capture of the Arnihem Bridge, which spanned the Rhine, proved too difficult and “Operation Market Garden” failed.  The Allies crossed the Rhine at Remagen in March 1945 and then the Germans surrendered in May of that year.

HHGM for 2019 was the Medicare bureaucrats “bridge too far.” They buckled to the political pressure from Congress, because a four percent decline in overall reimbursement and an unsubstantiated 11 percent behavioral adjustment factor was not explainable. Despite this, there are several elements of HHGM that will likely survive because Medicare is implementing in similar forms throughout the healthcare delivery system. These concepts include:

  1. Reduce the attractiveness of therapy to post-acute providers and focus more chronic medical patients who are likely to cost more monies in the long term. For rehab hospitals, raising the relevant diagnosis mix from 62.5 percent to 75 percent. For SNF’s, it is moving to RC-1, which does away with the ultra-high therapy designation and accounted for 50 percent of all therapy cases.
  2. Limit the amount of gaming of the system by finding ways to justify patients falling into the best paying categories. Even the political powerful insurance players is seeing its risk adjustment factor changed to limit the impact of upcoding.
  3. Don’t pay for services when the patients are not receiving them. Over 25 percent of all HHRG claims do not have a second HHGM claim associated with it.

CMS, like the Allies, will not give up their objectives. We can expect whatever new reimbursement system emerges to have these concepts as a key part of its philosophical foundation.  Administrations change, but career employees do not. Once they get an idea, they are tenacious about seeing it to its conclusion.

Join us next time as we move into Part III of our series when National Association for Home Care and Hospice President Bill Dombi considers the potential home health has to influence the greater healthcare industry.