LHC Group (Nasdaq: LHCG) Chairman and CEO Keith Myers is again calling on Congress to pass legislation refining the assumption-based payment adjustments currently outlined under the Patient-Driven Groupings Model (PDGM).
The co-founder of the Lafayette, Louisiana-based company recently penned an article in The Hill emploring legislators to pass S. 433, a new bipartisan bill that would require the Centers for Medicare & Medicaid Services (CMS) to base Medicare reimbursement rates on observed evidence rather than PDGM’s currently stipulated assumed changes.
“Assumptions put patients in the crosshairs as CMS waits to see if their assumptions are indeed accurate,” Myers wrote in the op-ed, published Saturday. “Assumption-based payment models are bad policy and will likely mean arbitrary rate reductions that could result in patients not receiving care they need in the home.”
Set to take effect in 2020, PDGM could destabilize the home health care industry and result in payment cuts of $1 billion — nearly 6.5% — if the reimbursement model remains unchanged, Myers and other industry leaders believe.
In his piece, Myers argues that S. 433 is the answer.
Introduced last week by Senators Susan Collins (R-Maine), John Kennedy (R-La.), Bill Cassidy (R-La.), Rand Paul (R-Ky.), Debbie Stabenow (D-Mich.), Doug Jones (D-Ala.) and Jeanne Shaheen (D-N.H.), the bill is similar to one of several PDGM opposition bills introduced last year, which Myers also backed.
Updates include fine-tuned language about “observed evidence” and phasing of payment changes, limiting losses or gains to 2% per year to ensure budget neutrality within 10 years.
“I have been a strong supporter of home care since my very first home visit early in my Senate service,” Sen. Collins stated after introducing the legislation. “This experience gave me the opportunity to meet and to visit with home health care patients, where I saw firsthand what a difference highly skilled, caring visiting nurses and other health care professionals make in the lives of patients and their families. I have been a passionate advocate of home health care ever since.”
If the bill altering PDGM’s reimbursement rates is not passed, the ramifications will reach far beyond home health, Myers argued in his piece.
“As these changes sit on the horizon, policymakers are considering the development of a unified post-acute care (PAC) payment model – bringing most post-hospital care settings under one payment umbrella,” Myers wrote. “Knowing a unified PAC payment system is likely in our future, it is even more important for Medicare to ‘get it right’ when it comes to PDGM – the largest payment reform home health has seen in two decades.”
Myers spoke in-depth with Home Health Care News in September about PDGM’s several changes as well.
In addition to refining PDGM, S. 433 also provides a pathway for expanded use of home health care in the Medicare Program without increasing program spending. Specifically, it provides flexibility on waiving the ‘homebound requirement’ for home health services when a health plan or innovative care delivery model — such as an accountable care organization (ACO) — determines that providing care to the patient in the home would improve outcomes and reduce overall spending.
“As plans and providers continue to experiment with innovative ways to deliver care and improve value in Medicare spending, allowing them the flexibility to waive this limitation — the homebound limitation — will help to advance the goals of ensuring that care is delivered at the right time, in the right place and at the right cost,” Collins said.
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