Medicare To Penalize 2,211 Hospitals For Excess Readmissions – Kaiser Health News
While we have yet to see significant reductions in the number of home health providers across the nation, discussions continue around the numerous variables that might impact such a decrease in number. Potential causes of consolidation in the home health industry have included conversations about reduced reimbursement, increased overhead as a result of various aspects of heightened scrutiny in benefits integrity, and an increase in competition in the form of ACOs, medical homes, and other models that will include acute care bundling. We have read about the significant impact rebasing of Medicare PPS rates could have in 2014, the unknown effect of co-pays on home health episodes, and the current challenges providers are having with increased pre-pay activity in the form of Additional Development Requests (ADRs) by the MACs (Medicare Administrative Contractors), the fiscal intermediaries for home health. More recent conversations among industry watchers have included managed care companies purchasing home care providers, i.e. Humana’s purchase of Senior Bridge. OIG, MedPAC, and CMS in its recent proposed rule have all alluded to moratoria on new providers, at least in states where there are increased aberrancies and convictions of fraud and abuse.
The Kaiser Health News article you will find at the link above adds two more potential factors that could impact a reduction in the number of providers, hospitals forming in house teams to visit patient homes post discharge and discharge planners limiting referrals to only those agencies who have lower readmission rates. While some home health providers have managed to convince hospitals we can make a difference it is obvious that we still have strides to make in this area. Granted, even the most clinically astute home care providers have had problems with readmission due to misaligned incentives. The home health agency wanted to keep the patient at home, but the physician saw less hassle if he sent the patient to the ER, and the hospitals’ revenues have been driven by admissions. That misalignment is changing with hospitals being penalized for readmissions. Perhaps now home care providers will see reductions on their own rehospitalization numbers.
But one of the relatively quiet conversations around ACOs and Post-Acute Bundling is the current environment of patients’ freedom of choice of post-acute providers, i.e. home health agencies. Hospitals across the nation are looking much harder at the who, what, when, where and why of discharge planning. The article linked above makes it obvious that some hospitals are literally taking matters into their own hands. Others are ‘vetting’ the post-acute providers to which they will refer patients, essentially demanding that chosen providers’ rehospitalization rates be lower. This means hospitals will find a way to limit their home health partners to those who can produce results. And the Medicare Compare site is the place smart discharge planner and hospitals will access to find accurate results.
Hospitals are being pushed to limit the number of home health partners to those with low rates of rehospitalization. If this factor is coupled with co-pays, which some regulators suggest will be aimed only at non-hospital or ‘community’ referrals, we will have a scenario that could significantly reduce the number of home health providers across the U.S. What steps are your agencies taking to be sure you are among that number?
Warren Hebert, RN
HomeCare Association of Louisiana
