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The discussion around home health provider-Medicare Advantage (MA) plan relationships has gotten tiring.
But is it over the top? I don’t think so. Right when I think I’ve written about the topic too much, I’m reminded again by a home health provider just how important it is.
And if you don’t believe me, here’s National Association for Home Care & Hospice (NAHC) President William A. Dombi, talking to me earlier this month:
“This is the generational battle. The battle we’re having today with PDGM and the payment rates pales in comparison to what needs to be done as the [MA] plans continue to grow,” he said. “We haven’t seen everything yet. … The plans tend to be on the younger side. Those younger people, when they age into the 70s, will start tapping into home health. That’s where the proportion becomes very scary, unless we solve the financial relationship between the plans and the providers.”
A lot of home health providers are still paid on a per visit rate by MA plans. Those rates – some of which haven’t ticked up in years – need to match inflation. But that’s just one of the relationship issues that needs solving.
Another one is increased administrative burden placed on providers, by plans.
“We need payers to stop playing what I call the home health care billing or revenue cycle ‘Uno’ game, where it’s always, ‘Back to you,’” John Kunysz, the president and CEO of Intrepid USA, told me last month.
Based in Dallas, Intrepid is a home health and hospice provider with more than 60 locations across 17 states.
Home health care is already dealing with one battle against the Centers for Medicare & Medicaid Services (CMS) around fee-for-service cuts. Time will tell if that battle can be won.
In the meantime, the troops need to be rallied for the next proverbial battle, this one with MA plans.
It doesn’t have to be a battle, either. I wrote last month about how home health-aligned MA plans could gain a leg up on competitors by bettering their relationships with providers right now.
This week’s exclusive, members-only HHCN+ Update is about what providers want – no, need – from MA plans to continue to keep the patients’ best interests at front and center.
A provider’s wish list
Sometimes a home health provider’s desires in the relationship aren’t tangible. That’s not the case for April Anthony, who spoke candidly with me on this subject recently.
If an MA plan’s per visit home health rate is at about $120, it’s hovering around 60% of what traditional Medicare would pay. Broadly, that’s too low for home health agencies to make any sort of margin, which is why VitalCaring – where Anthony serves as CEO – has had to turn the MA volume way down in select markets.
“There are certain markets where we’ve just turned the volume practically off,” she said. “In our Florida region, our cost structure is such that we just can’t cover even the cost of that $120 payment. We’ve just said, ‘We can’t take business where I pay you to care for your patient.’”
The Dallas-based VitalCaring provides home health and hospice services across six Southeastern states.
If that number came up to an average of $160 – closer to 80% of fee-for-service payments – it would be much easier for providers to take on MA referrals.
Anthony pointed out that MA home health rates haven’t ticked up much during a years-long period where nursing costs have risen by 30% or more.
Nick Muscato, the chief strategy officer at Amedisys Inc. (Nasdaq: AMED), expressed the same.
“There are a number of plans that pay per visit that have not given us a rate increase in one, two, three, four or even five years,” he told me. “Then they actually see the data. Clinician costs are up 37% in the last five years, [for instance]. When they see that data, it’s a little more compelling, but the cost has significantly outpaced the reimbursement increases.”
Based in Baton Rouge, Louisiana, Amedisys has 16,500 employees and over 522 care centers in 37 states and the District of Columbia. The company provides home health and hospice care, as well as palliative and high-acuity care in the home through its subsidiary, Contessa.
Providers would love payers to just give them more money, especially if the per visit payment is so low they can hardly cover it after the cost of care.
But that may not be the best way to get on better footing with plans. For instance, to scrap former agreements and make up new ones, Amedisys tends to throw multiple set-ups at a plan that they think will work.
“We’re always pitching multiple models to them,” Muscato said. “It’s a per visit rate increase, which is the least interesting, but we need it. But also, saying we would like to do a case rate with them. We also would like to talk about a palliative care arrangement, for instance. So, it’s not always just a single-threaded sale to them. There’s a number of different opportunities.”
In order to pitch multiple models, however, providers also need to be able to get in front of plans and have meaningful discussions about potential value- or risk-based agreements, Debra Konjanovski, the SVP of payer innovation at Enhabit Inc. (NYSE: EHAB), recently told HHCN.
“We spend time educating payers about how high-quality providers like Enhabit can reduce the overall cost of care,” Konjanovski said. “We also find that we are more nimble and innovative than some payers in what we can agree to and how we can handle reimbursements and payments. It takes time, energy and focus to move things forward, but we are putting in the effort to do so at Enhabit.”
The Dallas-based Enhabit has 255 home health locations and 108 hospice locations across 34 states.
There’s the tangible dollars, and then there’s the flexibility that providers want to see more of.
It’s not just about delivering home health services, either. It’s about doing away with the administrative games that Kunysz mentioned, and what Muscato called “ancillary contractors trying to grind out savings.”
Instead of being viewed as commodities, Kunysz believes that home-based care providers should be leveraged even further by plans to do more in the home.
“We’re going to be direct contracting with payers,” he said. “We should be providing care for these patients in home, taking care of things that normally would not be reimbursable by Medicare. For example: putting in ramps; changing furnace filters, so they don’t get lung infections or COPD, aggravation; spending time with their medications, and [ironing] those out. … Ultimately, it will be less costly if payers do this.”
Companies featured in this article:
Amedisys Inc., Enhabit Inc., Intrepid USA, National Association for Home Care & Hospice, VitalCaring
