A bipartisan group of U.S. lawmakers has begun planting the seeds to eliminate Medicare’s physician-certification policy — which many home health industry insiders have critiqued as outdated. If successful, the move could potentially make it easier for older adults to gain access to home health care and have a major impact on providers’ bottom line.
Introduced in April, the Home Health Care Planning Improvement Act of 2019 (H.R. 2150) aims to broaden the scope of who is allowed to certify the need for home health services under Medicare rules. Specifically, the legislation seeks to allow physician assistants, nurse practitioners and other advanced practice nurses to certify home health care services, theoretically removing physicians from the home-based care equation altogether.
House Lawmakers supporting H.R. 2150 include Reps. Jan Schakowsky (D-Ill.), Buddy Carter (R-Ga.), Ron Kind (D-Wis.), Mike Kelly (R-Pa.), Susan Wild (D-Pa.) and David Joyce (R-Ohio).
In general, the bill is an important step toward the future of health care and yet another example of care shifting into the home setting, Schakowsky told Home Health Care News.
“As we expand access to health care in all different settings, particularly in home health care, which is where people want to be, we have an obligation to make it cost-effective,” the congresswoman said. “And at the same time provide the quality care that is needed.”
An outdated system
Under current Medicare rules, home health services have to be certified — and re-certified — by a physician. It’s a process that, at times, leads to challenges for home health providers, as busy physicians can often be hard to get a hold of, leading to costly delays.
Allowing non-physicians to certify for home health services would alleviate that burden, Michael Willette, chief operating officer of VNA Care, told HHCN.
Massachusetts-based VNA Care is a subsidiary of Atrius Health that serves more than 50,000 patients each year. The organization is the largest nonprofit home health and hospice provider in the state.
“I see [the move] as ease of coordination to ensure that we can meet the needs of the patients in an expeditious manner, compared to right now, where it’s not a smooth transition,” Willette said. “I think that by streamlining under this new act, it will allow us to have a degree of immediacy to address the needs of the patient in a timely manner.”
VNA Care’s Willette isn’t the only home health leader to have lauded the legislative effort.
Washington, D.C.-based industry advocacy organization Partnership for Quality Home Healthcare has also supported the bill. Much of that support has come from Chairman Keith Myers, who serves as CEO of LHC Group Inc. (Nasdaq: LHCG) as well.
Myers reinforced the idea that H.R. 2150 would likely cut national health care spending if turned into law.
“The ability for patients to gain access to home health services would be much more efficient,” Myers told HHCN following his company’s Q1 earnings call with investors. “We know firsthand from experience — in markets where we have a number of nurse practitioners that are working in managed care products that are not Medicare — the early intervention of nurse practitioners in the home reduces overall health care spending.”
Medicare’s Hospital Insurance Trust Fund — which helps pay for Medicare Part A services, including in-patient hospital, skilled nursing facility, hospice and home health care services — is projected to go broke by 2026, according to the most recent Medicare Board of Trustees annual report.
“We all know that our aging population is growing and that the Medicare Trust Fund does not have unlimited funds available,” Myers said. “We all have a duty to be good stewards of the Medicare Trust Fund and not be wasteful.”
Additionally, enacting this legislation could lead to better outcomes for patients who would receive more face-time with nurse practitioners, people who are usually more knowledgeable about patients’ individual care needs, according to Myers.
“Quite often, the care is being certified by a physician who didn’t actually see the patient,” he said. “When nurse practitioners can certify, they are face-to-face with a patient in their home and can see the patient more accurately — and are able to determine what they need.”
LHC Group and its 32,000 employees deliver home health, hospice, personal care and facility-based services to patients throughout 36 states.
The bottom line
While the Home Health Care Planning Improvement Act has been well-received by members of the home health industry overall, questions remain regarding the bill’s precise bottom-line impact.
Generally, experts believe the legislation would have a positive impact on operations because of the likely increase in the utilization of home health services.
“I think this is a game-changer,” Myers said. “This is just one component of a movement that is shifting care from in-patient settings to the home. When care shifts to the home, there is more volume for home health providers.”
Willette shares a similar view.
“I definitely think that it would have a mostly positive impact across the board,” Willette said. “When you think of the direct cost associated with labor and the direct costs associated with coordination all of these activities, you can obviously streamline costs by integrating roles that are currently separated as a result of the way the system is designed.”
The National Association for Home Care & Hospice (NAHC), the American Association of Nurse Practitioners, the American Academy of PAs, the American College of Nurse-Midwives and the American Nurses Association are among H.R. 2150’s other supporters.
After being introduced, H.R. 2150 was referred to the House Committee on Ways and Means, in addition to the Committee on Energy and Commerce.
Given the strong bipartisan and industry support for the Home Health Care Planning Improvement Act, the legislation has a good chance of passing the U.S. House and making its way into the Senate, Schakowsky said.
“It’s a win for patients, a win for practitioners and a win for Medicare’s bottom line,” she said. “Empowering well-trained nurse practitioners and physician assistants’ is the way that we need to go to expand our health care workforce. This is a very important step forward in making health care accessible.”
Companies featured in this article:
LHC Group Inc, Partnership for Quality Home Healthcare, the American Academy of PAs, the American Association of Nurse Practitioners, the American College of Nurse-Midwives, the American Nurses Association, The National Association for Home Care & Hospice, VNA Care