Thursday, February 20, 2020
We already know about the family caregiver shortage. Now Kaiser Health News tells us it's harder for Medicare beneficiaries to get home health care. Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients explains the why, "home health agencies across the country are grappling with a significant change as of Jan. 1 in how Medicare pays for services. (Managed-care-style Medicare Advantage plans have their own rules and are not affected.)"
The article reports the results of this change, and how it's affecting beneficiaries: "[a]gencies are responding aggressively, according to multiple interviews. They are cutting physical, occupational and speech therapy for patients. They are firing therapists. And they are suggesting that Medicare no longer covers certain services and terminating services altogether for some longtime, severely ill patients."
This next section explains the before and after of payments:
Previously, Medicare’s home health rates reflected the amount of therapy delivered: More visits meant higher payments. Now, therapy isn’t explicitly factored into Medicare’s reimbursement system, known as the Patient-Driven Groupings Model (PDGM).
Instead, payments are based on a patient’s underlying diagnosis, the presence of other complicating medical conditions, the extent to which the patient is impaired, whether he or she is referred for services after a hospitalization or a stay in a rehabilitation center (payments are higher for people discharged from institutions) and the timing of services (payments are higher for the first 30 days and lower thereafter).
CMS is keeping an eye on the impact of this change, so pay attention to this issue. It's important!