CMS proposes home health pay changes, including remote monitoring
Centers for Medicare and Medicaid Services Administrator Seema Verma announced a slew of changes to the 2019 Home Health Prospective Payment System late on Monday, including a proposal to make the cost of remote patient monitoring an allowable cost for reimbursement.
The proposed rule would also implement a Patient-Driven Groupings Model (PDGM) for home health payments as opposed to a Home Health Groupings Model (HHGM), which would have resulted in an estimated home health spending cut of $950 million in 2019.
CMS estimates the proposed changes will result in increased Medicare payments to home health agencies (HHAs) of $400 million in 2019 and in a net $60 million in annualized cost savings to HHAs beginning in 2020.
The proposed changes come amid a push by all payers towards value-based care, increased competition and reduced administrative burden on physicians. The agency has already put in place proposals projected to save Medicare providers more than $144 million in 2019 and 2020, payment models tying payment to patient needs rather than volume of services provided, and more tailored Medicare Advantage plans.
The proposed rule would allow the cost of remote patient monitoring — including the cost of equipment, software and professional wages — on the Medicare cost report forms of home health agencies, an attempt to foster the adoption of new technologies and increase transparent care planning. Sharing this data will also support the Trump administration’s MyHealthEData initiative.
The PDGM update for home health payments is in line with the Bipartisan Budget Act of 2018 and, if approved, will be implemented at the start of 2020. The model would eliminate the use of "therapy thresholds" (the number of therapy visits a patient receives) in determining payment as well as change episode-of-care increments to 30 days, instead of the current 60, as therapy thresholds can promote volume over value.
Verma said that physicians ordering home health services for their patients will also see administrative burden reduced under the rule, as CMS is proposing to eliminate the requirement for physicians to estimate the length of additional skilled services and remove seven measures from the HH quality reporting program that were either unnecessary or redundant.
The update also provides information and solicits comments on the implementation of home infusion therapy temporary transitional payments, while proposing standards for home infusion therapy suppliers.
Height Commentary analyst Andrea Harris said that a lobbying push will ensue, given winners and losers in the for-profit versus nonprofit world.
"While the changes are now budget neutral, as mandated by Congress, reimbursement is projected to shift from for-profit HHAs to not-for-profit and government HHAs. We expect a major lobbying effort from the home health trade organization and changes are likely before CMS finalizes this proposal," she wrote in a note.
- Healthcare Dive New CMS database aimed at interoperability in post-acute care