A CMS final rule will increase payments for home-health agencies by 3%
in 2008, resulting in $430 million in additional payments next year, according to the
The home-health industry, however, took issue with a number of changes the rule makes on
case-mix policy, claiming payment rates will actually drop by nearly 12% over the next
four years. Case mix represents the variations in documented conditions of the patient
population served by the home-health agencies.
To account for changes in case mix that the CMS believes are due more to coding and
documentation practices than the home-health patients actual clinical conditions, the target="_new">final rule
target="_new">final rulereduces the national standardized 60-day episode payment rate for four years. A
reduction of 2.75% per year will take place from 2008 to 2010. In addition, there will be
a 2.71% reduction in 2011.
This represents a cut of nearly $7 billion, said Val Halamandaris, president of the
National Association for Home Care and Hospice, in a written statement. If these cuts are
put into place, over 50% of all home-health agencies will be paid less than it costs to
deliver care. No healthcare provider can sustain that impact, he said.
The rule also revises the home-health case-mix model to account for comorbidities, or
secondary conditions, and the differing health characteristics of longer-stay patients.
Home-health agencies collect and report Outcome and Assessment Information Set data, and
the CMS will continue to lower the payments to agencies that do not report the data.
Agencies that dont submit quality data on the 12 measureswhich include new measures
endorsed by the National Quality Forumwill receive only a 1% increase in 2008. The rule
is scheduled to go into effect in January 2008. -- by href="mailto:[email protected]">Jennifer Lubell
href="mailto:[email protected]">Jennifer Lubell
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