Home Health Leaders: Medicare Reforms Could Save More Than $15 Billion

The leading coalition of home health providers has put forth a proposal that could save more than $15 billion over 10 years by improving the Medicare pay model.

The Partnership for Quality Home Healthcare recently proposed Skilled Home Health and Integrity Program Savings (SHHIPS), which would move Medicare away from a “pay and chase” model by preventing payment of aberrant claims through firm payment safeguards, strengthened claims review processes, and tighter participation standards, including temporary entry limitations to prevent excess growth, the coalition says in a news release.

SHHIPS also includes important credentialing requirements, criminal background checks and a compliance program modeled on the Inspector General’s guidelines. 

The Partnership has also joined with organizations including AARP, Easter Seals, and the National Association for Uniformed Services in an initiative urging Congress to make program integrity reform a top priority. The Fight Fraud First! coalition urges action to combat waste, fraud and abuse.

Nationwide, nearly 3.5 million senior and disabled Americans rely on the Medicare home health benefit for cost-effective and patient preferred home healthcare.

Proposals to improve the Medicare pay model follow the House Energy and Commerce Subcommittee on Oversight and Investigations’ increased attention to the need for greater fraud prevention programs within the Medicare program. 

Data show Medicare fraud and abuse in the home health sector are isolated to pockets of the country, The Partnership says, adding that out of the nation’s 3,143 counties, the Medicare Payment Advisory Commission (MedPAC) has identified 25 counties in a total of five states where the majority of abuse impacting the home health benefit is occurring. The identified counties are in isolated areas of the country. 

“As the Medicare population continues to grow, it is essential to ensure the security of the Medicare program for generations to come,” says Eric Berger, CEO of the Partnership for Quality Home Healthcare. 

The Partnership also supports value-based purchasing and post-acute care reform, such as the recently introduced Bundling and Coordinating Post-Acute Care (BACPAC) Act of 2014.

“By encouraging the delivery of high-quality, cost-effective care, these innovative reforms would eliminate opportunities for unscrupulous individuals to take advantage of the Medicare program through wasteful, abusive and fraudulent activities,” The Partnership says.

Written by Cassandra Dowell

Cassandra Dowell