After a turbulent year in regulatory proposals for the home health care industry, providers need to be looking to 2018 with fresh eyes on what changes still lie ahead.
“2017 was arguably dominated by efforts to repeal and replace Obamacare,” said Fred Bentley, vice president of Avalere Health, a policy and financial consulting firm based in Washington, D.C. Bentley spoke at the National Leadership Conference on Wednesday, hosted by industry associations ElevatingHome, the Alliance for Home Health Quality and Innovation and VNAA.
However, it’s unlikely that 2018 will see the same sort of efforts, according to Bentley. Instead, providers need to be looking toward other Congressional changes, including those within the Bipartisan Budget Act of 2018.
In addition, providers need to pay attention to activity within the commercial market and how the current political administration is pushing forward new innovations.
Within policy changes, there are three main opportunities for home health care providers, according to Bentley.
Provisions in the Bipartisan Budget Act of 2018 included major reforms for home health care, including a new 30-day payment model by 2020. The model will replace the current 60-day payment period, but will likely keep the 60-day episode of care.
The model will also include a new case-mix reform and it eliminated therapy caps. The payments, overall, will be more closely linked to value, Bentley said, and providers will be expected to collect—and report—more data. This data will not be for “nothing,” he said, but will eventually be reflected in payments.
As payment reform continues and the model migrates toward value-based care, providers “must perfect clinical documentation,” Bentley said. “Payments will be based on it.”
Beyond direct policy, home health care providers can expect to be impacted by their upstream partners, such as health systems and hospitals, taking on more risk in alternative payment models. As physicians are paid increasingly based on value and health care outcomes, home health partners can expect to see their value also increase.
“CMS is in a major transformation in how physicians get paid,” Bentley said.
Providers within bundled payment models and accountable care organizations that can take on both the financial upside—gainsharing—and downside—penalties—will increasingly look to their post-acute partners for savings and high-quality care over the next several years.
Furthermore, the current administration at the Department of Health and Human Services (HHS) recently re-affirmed its intention to continue moving the health care system toward value-based care.
“Rest assured, the Trump administration is committed [from changing] a volume-based model to a value-based model, as much or more than the Obama administration,” Bentley said.
Many home health care providers have their sights set on other payer options, including Medicare Advantage (MA)—and for good reason. Currently, one-third of Medicare patients are enrolled in MA plans. The enrollment trend is also likely to accelerate over the next decade.
“The MA growth—that is significant when you think about how the Medicare population will be exploding by that time,” Bentley said.
However, MA plans aren’t yet paying home health providers as high of a reimbursement as fee-for-service.
“That’s the reality,” Bentley said of the current payments. “I’m not going to sugarcoat it—this is challenging.”
Long term, providers would still be wise to see a “huge opportunity” with Medicare Advantage, Bentley said. As more of the population enrolls with MA, home health care providers need to find a way to partner with these plans and redefine their role in the health care ecosystem.
Written by Amy Baxter