With Medicare Advantage (MA) enrollment poised to surpass traditional Medicare, home health providers will be forced to engage with plans, or otherwise, be left behind.
That’s according to William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC). Dombi expressed this viewpoint during his keynote speech at the Illinois HomeCare & Hospice Council (IHHC) conference on Wednesday.
It should come as no surprise to home health industry stakeholders that MA enrollment is on the rise.
Currently, MA has more than 28 million beneficiaries, or 45% of the Medicare population. By 2030, Medicare Advantage is expected to have over 52% of total Medicare enrollment, according to data from the research and advocacy organization Better Medicare Alliance.
“Clearly this affects you,” Dombi said. “At the same time, there is still the potential for some opportunities to come from Medicare Advantage. The reality being you need to embrace the opportunities. You need to deal with Medicare Advantage differently because of this trend, because if you don’t, you’re going to spiral out of control, as a business.”
That said, Dombi still expressed the importance of walking away when the rates being paid by MA plans are too low.
“The chairman of our board runs a nonprofit home health and hospice agency in Maine,” he said. “They just recently told three Medicare Advantage plans, ‘We’re gone, we’re not going to deal with you anymore, your payment rates are too low.’ The only leverage that you have is to be able to say ‘No’ to the plan.”
Dombi noted that for MA plans, the goal will be to get the best price they can — as is the case with most entities in the buyer position.
Other considerations
Aside from MA, Dombi also pointed to challenges that could present potential headwinds for providers, including rate cuts proposed by the Centers for Medicare & Medicaid Services (CMS) and increased oversight.
He also outlined NAHC’s legislative focus for 2023.
The organization expects to see the introduction of the Credit for Caring Act, which would provide a non-refundable federal tax credit of up to $5,000 to eligible family caregivers.
NAHC also hopes to see the reintroduction of the Choose Home Care Act, which would make room for more home health providers to deliver higher-acuity care in the home setting, and become more properly reimbursed for that care.
“We have rewritten that legislation, and we hope to see a reintroduction of it in the next month or two, but it remains very difficult,” Dombi said. “You have to have persistence when dealing with these things.”
Telehealth is also top of mind for NAHC, and thus, the organization is advocating for the reintroduction of the Home Health Emergency Access to Telehealth (HEAT) Act.
In 2021, lawmakers introduced S. 1309, a newer version of the HEAT Act. Prior to that, the HEAT Act had been introduced in both the House and Senate during the previous year.
Dombi believes that the passage of the legislation would modernize the home health benefit, as well as encourage proper utilization of telehealth services.
Plus, NAHC wants to see palliative care rolled into the Medicare home health benefit. This is a move the organization has been pushing for since at least 2020.
One roadblock, however, is that Congress is in gridlock, according to Dombi.
“There’s times like now when we need congressional action,” he said. “The barometer for Washington action in 2023 shows limited, or no chance, of any real action taking place. They are all preparing for the presidential election, and1/3 of the Senate and the entire House of Representatives will be up for election in 2024.”
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