Home health advocates held a rally on Capitol Hill last week to drum up support for a plan to kill the new Medicare home health reimbursement system, but a pair of reports will make their job a bit more difficult.
The new home health payment system, called the interim payment system, went into effect last Oct. 1. Congress designed it as an interim step before the Medicare home health program moves to a prospective payment system.
That was supposed to happen Oct. 1, 2000, but HCFA recently announced that because it's dedicating resources to the year-2000 computer problem, it won't be able to implement the new system on schedule.
Congress enacted the IPS as a way to rein in Medicare home health spending, which doubled to more than $17 billion from 1992 to 1997.
Home health groups say the IPS has cut payments and rewarded inefficient providers by locking in the cost-based reimbursement system that was in effect until October 1997. More than a dozen plans to alter or discontinue the IPS have been introduced in Congress.
The National Association for Home Care supports proposals to end the IPS and require retroactive repayment.
The NAHC and other groups say the IPS has led to a recent rash of home health agency closures.
But the General Accounting Office released a report last week that said closures of home health agencies have not made it more difficult for most Medicare beneficiaries to get home health services.
The GAO did say, however, that "access to services may be more difficult for beneficiaries with particular needs that make them likelier to be expensive to serve."
Home health advocates said the GAO report points to access problems for some patients and the need to fix those problems.
Another report released last week likely will damage the home health lobbying campaign.
Estimates by the Congressional Budget Office, which has the final say on how much any bill costs or saves the federal government, found that eliminating the IPS, as suggested by the NAHC, would cost Medicare nearly $21 billion in lost savings over the next five years.
"I don't see us passing anything that costs $20, much less $20 billion," said one House Democratic aide, who asked not to be identified.
Another battle is being waged between Rep. William Thomas (R-Calif.), chairman of the House Ways and Means Committee health subcommittee, and HCFA Administrator Nancy-Ann Min DeParle.
Thomas wants HCFA to introduce its own plan to overhaul the IPS, a suggestion DeParle has so far ignored.
Last week, Thomas and the other GOP members of the health subcommittee sent a letter to DeParle outlining several policy options and asking her to choose one.
A spokesman said HCFA would "continue to work" with Congress on changes to the IPS but would not say if HCFA would endorse any of Thomas' proposals.