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MedPAC policy could cut reimbursements for some home health agencies


By Virgil Dickson
Posted: January 16, 2014 - 7:30 pm ET
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Home health agencies with high readmission rates could see their Medicare reimbursement cut under a policy the Medicare Payment Advisory Commission voted to send Congress.

The policy could save the Medicare program anywhere between $50 million and $250 million in 2015 and just under $1 billion by 2020, the advisory panel said.

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The recommendation will appear in its annual March report to Congress. The proposal is “important because readmissions are (a) relatively common occurrence in home health,” MedPAC staff analyst Evan Christman told the panel Thursday. About 29% of post-hospital home health stays in 2010 ended in a return to a hospital, he said.

The HHS secretary would define what rate of readmissions is too high. The proposal says the rate should reflect the entire home health stay plus 30 days after discharge, and that the threshold should compare home health agencies to a peer group of providers who served a similar population of patients.

Even though the proposal was voted into the report, some panelists expressed some lingering concerns.

“Is there any risk of screening patients that have higher chances of readmission? Instances where home health agencies won't accept or care for certain patients?” asked Dr. Craig Samitt, president of HealthCare Partners, a large California-based physician practice owned by DaVita.

Others said they were concerned that Congress or HHS might pick a benchmark that's too punitive. “You can be better than average and still be subjected [to the cuts],” said Peter Butler of Chicago's Rush University Medical Center.

The panel also unanimously recommended that Congress ask HHS to implement a common assessment protocol for home health agencies, skilled-nursing facilities, inpatient rehabilitation hospitals and long-term care hospitals. The proposal is intended to facilitate comparisons of patient outcomes and costs across post-acute care settings.

Follow Virgil Dickson on Twitter: @MHvdickson


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