‘The most intense advocacy effort of my life’: Home health industry braces for rate cuts

Any day now, the home health final payment rule will be officially released by the Centers for Medicare & Medicaid Services (CMS).

As providers await his arrival, many of them are gathered in St. Louis at the annual conference of the National Association for Home and Hospice Care (NAHC). If the final rule is as bad – or nearly as bad – as the proposed rule, it will be a dark day for the industry.

It won’t be due to a lack of effort, however.

The main thing we are looking at is the 7.69% rate cut – will that happen or not? NAHC President William A. Dombi said at the conference Sunday. “We have been engaged in the most intense advocacy effort I have experienced in my life. And I’ve been doing advocacy for a few years. The effort we have underway brings all forms of advocacy.

Unlike years past where a certain provision could cause concern for providers in the proposed rule, this year’s one – if finalized as proposed – will threaten their very existence.

Dombi noted that about 51% of home care providers would be operating in the red if the rate reduction materialized for 2023, according to an NAHC analysis.

This number also assumes that agencies will not change the way they run their businesses. Of course, they will have to if there is an overall 4.2% decrease in home health rates.

There are also concerns that the estimated 4.2% cut could be more severe than CMS suggests.

“First of all, just this overall impact,” Scott Pattillo, chief strategy officer at Homecare Homebase, told Home Health Care News earlier this month. CMS predicted that the proposed rule this year would result in a 4.2% reduction in the industry. Across all of our aggregated models, using 36% of the data – which we think is a pretty good representative sample – we see a 5% reduction in reimbursement. This will create an even greater impact on access to care.

That’s why NAHC and others have taken this three-pronged approach to advocacy: the regulatory front, with Congress on the Preserving Home Health Care Act, and preparing for a legal battle when the rule is finalized.

Dombi also noted that this is strong support for the home health industry as it battles rate cuts in Washington, DC. That support is on both sides of the aisle, and in Congress and the Senate.

“Our allies in Congress have stepped up beyond anything I’ve ever experienced,” Dombi said.

Although a proverbial dark cloud hung over the speech, the preparation and advocacy the industry took gave hope to Dombi and other leaders as final rule approached.

“The CMS administrator probably had nauseating conversations at this point with members of Congress, with us, and with many others,” Dombi said. “We are on the edge of our seats waiting to see what happens. If we give a blind prediction, the prediction is that we think we are in on it. We have a meeting scheduled no later than Thursday of this week with the director of the Office of Management and Budget. They wouldn’t give us this meeting if they didn’t want to hear what we had to say again.

The aforementioned legal battle would come after a negative final rule is finalized and possibly even after these rates are implemented in 2023.

Given the recent success of hospitals in fighting a rate cut in court — as well as other general legal trends in the United States — home health officials are right to believe they would have a strong case. against CMS and the US Department of Health and Human Services.

“We always consider litigation as a last resort,” Dombi said. “At this time, we have carefully prepared the legal arguments presented both on the regulatory front and in Congress along the way, and we will do everything we can to protect your interests. The only thing I believe this advocacy staff does as well as anyone, if not better than anyone else is that he doesn’t give up and you don’t either, so we look forward to teaming up with you in as we will need it in the future.

About John Tuttle

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