‘The Wrong Policy At The Wrong Time’: Home Health Industry Continues To Fight CMS Cuts

The Senate Finance Committee’s Subcommittee on Health Care recently held a hearing centered around home health care and aging in place in the U.S.

The hearing covered a number of topics, including the Centers for Medicare & Medicaid Services’ (CMS) home health payment cuts, referral rejection rates, the Medicare Payment Advisory Commission’s (MedPAC) view of the industry and more.

The general consensus of many of the home health stakeholders that attended was that the hearing was a success.

Joanne Cunningham, the CEO of the Partnership for Quality Home Healthcare, agrees with this line of thinking. She joined Home Health Care News for the latest episode of the Disrupt podcast to discuss the ins and outs of the hearing and her optimism regarding the upcoming home health payment rule.

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Below are takeaways from that conversation, edited for length and clarity.

HHCN: Last week there was this hearing put on by the Senate Finance Committee’s Subcommittee on Health Care. The hearing focused on aging in place, and challenges facing the home health care provider and patient community in the US. How did this hearing come about in the first place?

Cunningham: Way back in the beginning of the year, we had been speaking with many of our allies on the Hill who are very interested in home health. Sen. Ben Cardin (D-Md.) was very interested in holding a hearing on home health, and his staff had been working with us since February. We gave a lot of ideas, and they had their own ideas, and through that process came about the hearing.

Can you explain the format of the hearing and what was discussed over the two hours or so?

The hearing had a total of five witnesses, and these were folks that we suggested, and, as mentioned, Senator Cardin. We had Bill Dombi, who is the president of the National Association for Home Care & Hospice. He was there, not just as an expert on the Medicare home health program, but really home care and care in the home generally. They also invited a provider from the state of Nebraska. Her name was Carrie Edwards. They also had an academic from the University of Washington, who has done a lot of research in the area of care at home, especially from a rural perspective. Then there was Judy Stein from the Center for Medicare Advocacy and a former MedPAC commissioner.

In terms of who was there, including in the audience, what were your feelings on that? It seemed like it was well attended.

It was a packed room. I saw a lot of folks who understand the provider perspective and advocate for home health care.

From the get-go, the hearing seemed like it was immediately off to a good start. There were many members of the Senate Finance Committee, both Republicans and Democrats. The chair of the Senate Finance Committee, Sen. Ron Wyden (D-Ore.) came for a good chunk of the early part of the hearing. Sen. Debbie Stabenow (D-Mich.), who’s been a huge advocate for home health and care in the home, came.

I was also struck by how much engagement there was, and really the insightful questions that Senators asked.

I talked to Bill Dombi yesterday, who, as you mentioned, was a witness at the hearing. He said that he left the meeting on an emotional high. How did you feel afterward?

I agree, it was a really good discussion.

The best part about it was just how brightly it shined a light into how important care in the home is. In particular, the Medicare home health program. It’s such a lifeline for older Americans.

I’m not surprised that Bill felt on an emotional high. We all felt that. Many of us have been working in this home health sphere for many, many years. We believe in this program. There’s nothing better than seeing someone — who has gone through a surgery, or is in need of some kind of services to help monitor their condition, or recover or rehabilitate — receive those services in their home. I thought the hearing was just a great showcase of just how important that is.

You mentioned the home health provider voice that was there. That was Carrie Edwards from Mary Lanning Healthcare. I’ll just lay out a few of the things that she mentioned. Her agency previously covered a 13-county, 60-mile radius; they had to reduce that because of staffing issues and rate cuts to a 40-mile radius earlier this year. And then, more recently, to a 25-mile radius. Her agency is declining 50% of referrals. I thought that was really important because sometimes MedPAC views access as how many agencies there are per zip code.

I thought that was a great thread of questioning and discussion. We see the data and the very limiting metric that is used. You have “access” just because that agency serves your zip code as part of their delivery area. But we all know that unless you can actually receive services when you need them, your access is not real.

I thought that whole thread of discussion was just so revealing of some of the challenges that patients have. I think Carrie did such a good job of highlighting what happens to that Medicare patient who’s in a hospital bed, who needs home health care services. The discharging physician has ordered the services, and there’s no capacity for an agency to deliver them. That patient either stays in the hospital, or they go home without services, and they probably end up back in the hospital via the emergency room. Sometimes they’re headed for a skilled nursing facility.

Were there any other big takeaways that you had from things that were said during the hearing, whether it was from witnesses, or from senators?

The other takeaway, I would say, was just the knowledge level of home health care from the senators. They each had their own lens and asked questions that were through that lens. I thought the discussion on workforce was also a really good deeper dive into a huge problem that is exacerbated by CMS policy. We need resources in order to pay those nurses and pay those clinicians appropriately.

It seems like we’re moving in the opposite direction, and the CMS policy is exactly the wrong policy at the wrong time. I thought that there was just a lot of base knowledge that was very deep from really all of the senators.

As we approach October, with the final rule coming then, or maybe in early November, what is your feeling now on how that final rule will end up? Are you more optimistic than you were prior to the hearing?

I’m always optimistic. I talked to a lot of policymakers on the Hill. There’s a lot of support for home health care.

There’s an understanding of how important it is. When we have a hearing which showcases that, it does make me more hopeful. We have to make sure our message is heard by CMS. These reimbursement cuts are a direct line to a decrease in access to care. We need CMS to feel the pressure of policymakers from lots of different corners who are saying this doesn’t make sense.

Let’s re-do this, let’s retract these cuts, because they’re having a detrimental impact on seniors’ ability to access health care at home. Let’s pause, let’s take a step back here. I’m optimistic, but I’m on pins and needles, as all of us who work in the home health community are. We’re going to keep working until the final moment in order to make sure that our voices are loud and that they’re heard.

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