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Home Health Patients Must Be Protected From Medicare Cuts | Commentary

Health care in America is undergoing significant transformations. Changes in the delivery of health care and how Americans access care are front and center in today’s policy discussion.

As colleagues in the U.S. House dedicated to protecting the health care needs of our senior and disabled constituents, we agree that access to clinically appropriate care in the most cost effective setting is of utmost importance in properly caring for our nation’s growing Medicare population.

Home health care is a vital solution to improving patient health while also decreasing costs. Home health allows patients to receive low-cost care in the safety of their homes, which reduces Medicare expenditures in more expensive institutional care settings. That’s why we believe Medicare should support and encourage the delivery of home health care.

We are concerned that a proposed rule issued by the Medicare agency will do just the opposite.

The Centers for Medicare and Medicaid Services has proposed cutting Medicare home heath funding by 14 percent in its Home Health Prospective Payment System rule. By rebasing home health payments by 3.5 percent over four years, Medicare will reduce home health funding by an estimated $21.5 billion.

Our concerns are twofold.

First, we fear the proposed rule is based on incomplete data and therefore rebases home health payments at a rate far too high. The rule doesn’t appear to account for all of the operating expenses incurred by home health agencies when delivering home-based clinical care services. For example, new tele-health technologies that are drastically improving care delivery aren’t accounted for in the CMS’ calculations.

Second, the proposed rule doesn’t evaluate the impact of the rebasing policy over all four years in which it is to occur, during which time Medicare home health payments are already scheduled to experience payment reductions. Absent the rebasing provision, Medicare home health payments are already set to drop 20 percent.

We recently joined 140 of our colleagues in the House in asking the CMS to provide a complete impact analysis of the proposed rule so we can fully understand how the rebasing cuts would influence the delivery of home health care to the 3.5 million Medicare beneficiaries served each year. Furthermore, considering that 90 percent of the nation’s home health agencies are categorized as small entities, it must directly address how payment reductions would affect small-business operations.

The U.S. Small Business Administration has expressed concern that the proposed rule doesn’t go far enough in evaluating how it will impact small entities, including small-business home health agencies and nonprofit organizations.

Community leaders and senior advocates, too, are urging the CMS to ensure that the methodology used to calculate rebasing carefully considers the impact on beneficiary access and quality of care.

As one of the Medicare program’s most disadvantaged patient populations — many of whom live in underserved and rural communities — home health beneficiaries are uniquely vulnerable to patient access challenges as well as chronic disease and medical conditions that can benefit immensely from the delivery of home health.

In California, for example, many home health patients live in medically underserved areas. A full 72 percent of California home health beneficiaries are located in health professional shortage areas. And in West Virginia, half of our home health patients reside in rural areas. These two populations are particularly at risk when unsustainable Medicare cuts take effect.

A resounding chorus of voices is speaking out about the missteps taken in crafting this rule. We hope regulators at the CMS will listen and undertake a more detailed analysis of the rule using the most reliable data. It’s essential that the agency do its due diligence in fully assessing the results of their policies to ensure their proposal doesn’t negatively affect home health delivery to Medicare beneficiaries or patient health care outcomes.

Protecting health care for America’s seniors and disabled isn’t a partisan issue. It’s what our senior constituents deserve.

Rep. Doris Matsui is a Democrat from California. Rep. David B. McKinley is a Republican from West Virginia.

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