The home health industry moved one step closer to a monumental victory on Wednesday after the U.S. Senate overwhelmingly voted in support of a $2 trillion stimulus bill.
Most notably, the bill seeks to allow non-physicians to certify for home health services and take charge of patients’ care plans, an authority home health stakeholders have been requesting for more than a decade. While non-physician certification is a boost to home health providers generally, it’s especially important during the COVID-19 pandemic, a time when physicians are increasingly being stretched thin.
Now that it has moved out of the Senate, it’s up to the U.S. House of Representatives to vote on the giant relief package. An expedited voice vote is expected to come Friday morning, though there’s some uncertainty whether any representatives will hold up the process by asking for a recorded vote.
“Our nation faces the worst pandemic in over fifty years,” House Speaker Nancy Peosi, a Democrat from California, said in a statement. “Urgent action continues to be needed to address this threat to the lives and livelihood of the American people.”
For home health providers keeping track of the action, there’s more than just non-physician certification at stake.
Apart from directing the Centers for Medicare & Medicaid Services (CMS) to move forward with non-physician certification, the stimulus bill also allocates about $100 billion to help health care organizations cover costs associated with COVID-19. About $65 billion will go to hospitals, with the remainder distributed throughout the rest of the U.S. health care system, according to CNN.
National Association for Home Care & Hospice (NAHC) President William A. Dombi touched on the $100 billion fund and what it means for home health providers during a Thursday online video address.
“Much of the detail is missing, but the one thing we do know is that [the fund] will focus on the cost of COVID-19,” Dombi said. “It’s essential that you keep track of any COVID-19-related costs to have the opportunity to acquire some funding through this $100 billion relief effort.”
Already, it’s becoming clear that COVID-19 — the novel coronavirus — is having a bottom-line impact on providers.
Stocking up on personal protective equipment (PPE) is one cost consideration. Other bottom-line impacts include operational disruption from office staff working from home and losses tied to visit cancellations.
Amedisys Inc. (Nasdaq: AMED) CEO Paul Kusserow told USA Today that his company has seen significant cancellations.
“The ICUs will fill up. There will be overflow. People will be sent home,” Kusserow said. “They are going to need care and monitoring. We’re in the right place to do it. The home is the right place for this. But we need to have all the tools we need to do our job.”
The non-physician certification provisions originally come from the Home Health Care Planning Improvement Act.
Medicare sequestration ‘holiday’
As currently written, the $2 trillion coronavirus stimulus bill also includes language that would temporarily bump up Medicare reimbursement for home health providers.
Under the Budget Control Act, CMS began reducing payments to all fee-for-service Medicare providers by 2% in 2013. The practice — known as sequestration — has been going on since then, with no real end in sight.
If passed by the House and signed by President Donald Trump, the relief package would include an eight-month “holiday” from Medicare sequestration, Jefferies analysts Brian Tanquilut and Jason Plagman confirmed in a note. Specifically, sequestration will be paused from May 1 to Dec. 31, 2020.
“In effect, this provision would increase Medicare reimbursement for home health and other Medicare providers by 2% during the sequestration ‘holiday,’” the Jefferies analysts wrote.
For a reference point, Jefferies estimates the eight-month pause would increase Medicare home health revenue by $15 million for LHC Group Inc. (Nasdaq: LHCG). Similarly, Amedisys and Encompass Health Corp. (NYSE: EHC) would both see a projected revenue bump of $12 million, according to Jefferies.
Although a 2% bump isn’t huge, it’s further support for the home health providers struggling with the transition to the Patient-Driven Groupings Model (PDGM) and the overhaul’s 4.36% behavioral adjustment.
Furthermore, a 2% bump could help offset some of the losses providers are seeing now that elective procedures — hip and knee replacements, for example — have been postponed.
CMS data indicates that only 2% of home health volumes are expected to be coded under the “surgical aftercare” clinical grouping in PDGM, Tanquilut and Plagman stated in their note. Still, some musculoskeletal rehab cases may be affected by delayable surgical procedures.
“Our overall view is the vast majority of home health episodes are related to urgent and acute medical, nursing or therapy needs rather than post-operative recovery,” they wrote.
Broadly, non-physician certification means nurse practitioners, physician assistants and others could have bigger roles in the home health hierarchy in the future.
It also means bigger roles in the battle against the coronavirus.
“Fast-tracking [the Home Health Care Planning Improvement Act] by including it in the emergency COVID-19 legislation was critical,” David E. Mittman, president and chair of the American Academy of PAs’ board of directors, said in a statement. “With the ability to order home health services, PAs can help to free up hospital beds for COVID-19 patients and decrease the spread of the virus by moving patients back into the home setting, away from exposures to the virus.”
The Home Health Care Planning Improvement Act was introduced into the Senate last year by Susan Collins (R-maine) and Ben Cardin (D-Md.). The House version was introduced by Reps. Jan Schakowsky (D-Ill.), Buddy Carter (R-Ga.), Ron Kind (D-Wisc.) and Mike Kelly (R-Pa.).
In total, the bipartisan legislation had 47 co-sponsors in the Senate and 140 co-sponsors in the House.
“The Senate’s vote last night ensures that millions of seniors are able to receive critical health care services at home ― at this crucial time for the health of our nation,” Sophia L. Thomas, president of the American Association of Nurse Practitioners, said in a statement. “Not only will the legislation help make certain seniors have timely access to home health care, it will also help ensure they are less likely to be exposed to [COVID-19] by being forced to seek health care at hospitals and other facilities.”
Home health highlights go even further than non-physician certification, the $100 billion health care fund or the Medicare sequestration holiday.
In addition to all that, the stimulus package also implores CMS to “encourage” the use of telehealth technology among home health providers.
“This is not direct reimbursement relief,” Dombi said in the video. “It fell short of what we’re looking for, but we were told by Congressional staffers that CMS has indicated its willingness to provide some kind of reimbursement relief related to telehealth.”
Telehealth action could come in the form of a CMS rule currently pending Office of Management and Budget (OMB) review.
In today’s market, many home health providers also offer hospice services. The delivery of hospice care may likewise be changed as a result of the stimulus bill, formally titled “the Coronavirus Aid, Relief and Economic Security (CARES) Act.”
If finalized later this week, the CARES Act would allow hospice providers to perform face-to-face encounters via telehealth, a flexibility recently granted to home health providers as well.
“Flexibilities are needed to meet these very challenging circumstances, and we are heartened to see some measures that we have been advocating for were included in the stimulus legislation that the Senate passed [Wednesday],” Edo Banach, president and CEO of the National Hospice & Palliative Organization (NHPCO), said in a statement.
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