Home health and dialysis providers will get modest Medicare reimbursement increases in 2025 under final rules the Centers for Medicare and Medicaid Services issued Friday.
Medicare home health payments will rise 0.5% next year after the agency proposed a 1.7% cut in June. Dialysis providers treating end-stage renal disease patients are set for a 2.7% reimbursement hike, higher than the 2.2% CMS proposed in June.
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The home health prospective payment system final rule reflects the continued implementation of the Patient-Driven Groupings Model, or PDGM. This formula bases reimbursements on patient characteristics rather than therapy hours and sets payments based on 30-day episodes instead of 60 days.
"A net increase in Medicare spending projected for 2025 does not address the several years of unwarranted rate cuts and the shortfall in recognizing the significant inflationary pressures and cost increases that have been incurred. In no way can CMS defend its actions as 'budget neutral," National Alliance for Care at Home CEO Dr. Steve Landers said in a news release. “We need help from Congress to end this assault on the Medicare home health benefit," he said.
The net change to home health payments is the difference between a 2.7% market basket increase, a 1.8 percentage point offset from PDGM and a 0.4 percentage point reduction in the fixed-dollar loss ratio for outlier payments, according to CMS.
The end-stage renal disease prospective payment system final rule also includes a payment bundling plan that includes oral-only drugs for kidney disease patients with high phosphorus levels, which the industry opposes.
