At the beginning of the month, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the 2021 Medicare Physician Fee Schedule.
Since then, the rule has drawn criticism for the payment cuts CMS made to home-based primary care visits, a move that experts believe will jeopardize access to care for seniors and chronically ill patients. That’s especially true considering the ongoing public health emergency, when in-home care has never been more important.
Similar to the home health payment rule, CMS’s Medicare Physician Fee Schedule mandates how much Medicare physicians get paid for providing care in 2021.
Under the rule, home-based primary care saw an 8% to 10% payment cut to visits. One of the many organizations that has been critical of the cut is the American Academy of Home Care Medicine (AAHCM).
About 2 million seniors are permanently homebound, according to AAHCM. For seniors who fall under this category and certain others, receiving care outside of the home can be difficult — or impossible.
“One concern if this doesn’t get reversed or reconsidered by policymakers is that with the effective rate cuts to home-based medical care providers, the exact patients who we are trying to protect by not having to go to a clinic, hospital or urgent care facility will be impacted,” Theresa Soriano, president of AAHCM, told Home Health Care News. “If you are reducing rates by 10%, you’re going to threaten the ability of these largely small practices to be able to provide care quickly and on a large scale.”
Soriano also noted that home-based primary care providers are often delivering care to those who are most at risk for adverse health complications if they were to contract COVID-19.
Chicago-based AAHCM is a professional and advocacy organization that represents physicians, nurses, physician assistants, social workers and other health care professionals dedicated to working in the field of home-based medical care.
CMS’s payment cut to home-based primary care visits could also spell trouble for smaller providers and have long-term implications for the industry as a whole.
“Many of my colleagues are extremely worried that smaller practices — those that are not affiliated with large health systems or [similar] entities — will really struggle, and may either have to downsize or even close,” Soriano said. “This is not urban or rural — all parts of our country are being served by home-based medical care.”
Soriano pointed out that the recent rate cut was accompanied by a rate increase for primary care providers that don’t work in the home setting, which may speak to an oversight on CMS’s part.
“Office-based primary care is effectively seeing an increase in their reimbursement, which is appropriate and right,” she said. “We want people to be getting the care they need, but considering that the care we are providing is in an arguably safer setting, we just believe that there was a … lack of recognition that home-based medical care is primary care and should not be seeing a rate cut but the same increase,” she said.
In order to combat CMS’s decision, AAHCM has thrown its support behind legislation under consideration which would delay the cuts. The organization considers this a temporary solution.
Moving forward, Soriano believes that it’s important for providers to reach out to Congressional representatives, as well as CMS.
“Something that we are doing is reaching out to our state representation, both on the Senate and House side,” she said. “And to CMS, to make them aware that primary care and home-based medical care are related. Home-based medical care is a subset of primary care and needs to be recognized in the same way.”