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Congress: Fight for Medicare Home-Health Reforms

The entry of a new Congress last month signals a renewed opportunity for strengthening America’s Medicare program to ensure we are prepared to meet the health needs of an increasingly larger patient population with increasingly complicated and chronic care needs.

A health care setting that is essential to meeting this growing need — yet is often misunderstood and overlooked — is the home.  For decades, home health care has served as an important part of the Medicare program, enabling seniors to receive high quality, coordinated health care in the lowest cost setting available.

Despite the documented clinical and fiscal benefits of home health care, policy threats and financial obstacles remain to both the delivery of quality home health care and access to home care for America’s most vulnerable patient group.

These very real implications are most evident in how recent cuts to home health care under the Affordable Care Act stand to negatively effect patients, health care workers and American businesses. The ACA cut the Medicare home health program by 14 percent over four years. The budgetary assault will force “approximately 40 percent” of all home health agencies into the red by 2017, according the Centers for Medicare and Medicaid Services.

This unprecedented funding cut, according to data by Avalere Health, could leave 1.3 million vulnerable seniors without the home health care they need, more than 450,000 home health clinicians without work and more than 4,500 small businesses in bankruptcy.

In response to these challenges and other health care system inefficiencies, home health care leaders have come together to develop and put forth solutions that, if advanced in Congress this year, could result in sustainable reforms to successfully improve patient care, secure patient access and save Medicare dollars.

In 2014, the home health community led a variety of initiatives to strengthen the Medicare home health benefit and reform the post-acute care delivery system while also advancing reforms to protect and safeguard vulnerable senior patients.  

Most notably, Reps. Greg Walden, R-Ore., and Tom Price, R-Ga., introduced the Securing Access Via Excellence Medicare Home Health Act (HR 5110) to replace the ACA cuts with value-based purchasing and hospital readmission reforms that reward positive outcomes. The bill, which has the potential to produce savings and enhance patient care, continues to gain support in Congress.

In addition to repealing the ACA home health cuts, home health leaders stand ready to work with our counterparts across the post-acute care (PAC) community to advance much-needed PAC reforms. To that end, we strongly support the Bundling and Coordinating Post Acute Care Act to establish bundled payments for PAC services and use PAC coordinators and their networks of care providers to manage care under site-neutral bundled payments.

Finally, we firmly support program integrity reforms within the Medicare program to protect patients, providers and taxpayers alike. Bold reforms, including the Skilled Home Health Integrity and Program Savings Act that targets Medicare fraud and abuse by preventing the payment of aberrant claims, strengthening the claims review process, improving participation standards and establishing temporary entry limitations to prevent excess growth, are critically needed to reduce spending and shore up the Medicare Trust Fund.

Without serious attention and broad support from Congress, these positive Medicare reforms will not benefit the Americans who need them most — our vulnerable senior and disabled populations.

According to an Avalere Health study, 60 percent of Medicare home health beneficiaries are women. The same population is also older, poorer, sicker and more likely to be minorities than the rest of the Medicare beneficiary population.  

Home health is also particularly important to seniors in rural communities where it is difficult to access medical facilities. The ACA cuts compound this issue, making it increasingly difficult for rural seniors to receive necessary care because of fewer agencies treating more patients.

But by supporting Medicare home health reforms, Congress can better protect these patients.

Ultimately, the midterm elections proved that Americans want a change of course. The new Congress finally has the chance to set our nation’s health policy decisions on the right track in 2015. The first step is a powerful devotion to the health and wellbeing of legislators’ most vulnerable senior constituents.

In 2015, the home health community will continue fighting for the policy reforms we believe are necessary to make high-quality, low-cost care at home an option for all Medicare patients who could benefit from home health care. It is now time for Congress to fight for these reforms too.

Billy Tauzin is a Republican from Louisiana, who served in the House of Representatives from 1980 to 2005. He currently serves as senior counsel to the Partnership for Quality Home Healthcare.

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