Trump’s HHS Pick Opposes Pre-Claim, Joint Bundles

A leading critic of a wildly unpopular home health regulation may soon be in a position to get rid of it entirely, as the Secretary of the Department of Health and Human Services (HHS).

In late September, Rep. Tom Price (R-GA) introduced a bill to hit pause on the Pre-Claim Review (PCR) demonstration; PCR had provoked outrage from home health providers after being implemented in August. Now, President-elect Donald Trump has chosen 62-year-old Price, an orthopedic surgeon, to head up HHS.

The National Association for Home Care & Hospice (NAHC) worked on that pre-claim bill with Price, and praised his expertise Tuesday.


“He has a deep understanding of the value of home care and hospice that we expect will be key to his actions with Medicare and Medicaid,” NAHC President Val J. Halamandaris stated.

Similarly, the Visiting Nurse Associations of America (VNAA) focused on Price’s recent actions on pre-claim. Under the PCR program, agencies must submit documentation to auditors for authorization before filing for Medicare payments. Agencies have said that it imposes huge burdens, has been poorly run, and threatens to cut off cash flow to unsustainable levels.

“VNAA is grateful to Rep. Price for his strong advocacy on behalf of home-based care by co-authoring a letter to CMS opposing the implementation of a demonstration that requires prior authorization for certified agencies to bill for physician-referred Medicare home health services,” stated VNAA Vice President of Policy and Innovation Joy Cameron. “Following CMS’s August rollout of the Pre-Claim Review Demonstration program and its resulting problems in Illinois, Rep. Price introduced (along with Rep. McGovern) the Pre-Claims Undermine Seniors’ Health (Push) Act (H.R. 6226).”


PCR currently is in effect only in Illinois, but currently is set to roll out to four additional states. The timing of that rollout is uncertain, however, and the current pause could extend through Trump’s inauguration in January.

Bundled payment pushback

While home health providers would hail Price if he should eliminate PCR, other potential issues might not be as clear-cut.

Bundled payment programs appear to be driving more patients to home health, but they could be curtailed on Price’s watch. He has been an outspoken critic of making bundled payment programs large-scale and mandatory, zeroing in on the Comprehensive Care for Joint Replacement (CJR) program specifically.

Under this mandatory bundled payment initiative, hospitals see their Medicare payments tied to the costs and outcomes for a full 90-day episode of care for orthopedic patients. The concept is that the hospital will be incentivized to coordinate care with post-acute providers to control spending and keep quality high.

In late September, Price harshly criticized the CJR program in a letter to Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS). CMS overstepped its authority in rolling out these large-scale, mandatory programs through the Center for Medicare and Medicaid Innovation (CMMI), Price wrote. CMMI was created under the ACA to test new care and payment frameworks on a limited, voluntary basis, and pushing too far and too fast with these initiatives comes with great risks, he argued.

“These mandatory models overhaul major payment systems, commandeer clinical decision-making, and dramatically alter the delivery of care,” the letter states.

Price and other co-signers of the letter urged CMS to cease all current and planned mandatory initiatives. As head of HHS, Price soon could be in a position to make sure this occurs.

If he does, it may be met with a mixed reaction from home health providers.

On the one hand, initiatives such as CJR have represented an opportunity for home health to gain more hospital referrals, and they appear to be successfully cutting costs. Some large home health companies already have shaped their future strategies around playing key roles in bundled payment programs.

But the National Association for Home Care & Hospice (NAHC), the Alliance for Home Health Quality & Innovation (AHHQI), and the nation’s largest home health provider, Kindred Healthcare (NYSE: KND), have all urged CMS to slow down the pace of mandatory bundled payment programs. CMS has made moves to expand mandatory bundles for other care episodes, including heart conditions.

ACA repeal

Beyond these home health-specific policies, it is widely expected that Price will execute on Trump’s campaign pledge to repeal and replace the Affordable Care Act entirely.

Price has in the past proposed the Empowering Patients First Act, which would have repealed the ACA and put different policies in place, such as age-adjusted tax credits for the purchase of health insurance policies, grants to subsidize insurance for “high-risk pools,” and relaxed rules over where insurance companies can sell policies.

It remains to be seen how a Trump administration would set about dismantling President Obama’s sweeping health care reform law, but Price would play a key role, as would the incoming administrator of the Centers for Medicare & Medicaid Services (CMS). For this post, Trump has chosen Seema Verma, founder and president of a health policy consulting firm. She also worked closely with Vice President-elect and current Indiana Governor Mike Pence on the Medicaid expansion in the Hoosier State.

Although these appointments start to give a firmer idea of what health care policy may look like under President Trump, it still is early days, and much uncertainty remains. In this period, home health groups are working to make their voices heard.

“While the Administration is working to develop policy positions and strategies, VNAA is working to ensure that the Administration and Congress are well-aware of the value of home health care and the role it plays in providing efficient, cost- effective high quality care,” Cameron stated.

While NAHC and VNAA focused on potential benefits to home health under Price, his appointment sparked backlash from other groups.

Planned Parenthood warned that Price could present a “grave threat to women’s health,” given his position on issues such as abortion and birth control. And the president of the Gay and Lesbian Alliance Against Defamation (GLAAD), Sarah Kate Ellis, blasted Price as “completely unfit” for the job of HHS secretary. Price called it a “sad day for America” when the Supreme Court ruled in favor of same-sex marriage in 2015.

Written by Tim Mullaney

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