Home Health, Hospice Play Vital Roles in Reform Efforts

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Home Health Hopsice Agencies Role in ReformTestifying before the U.S. Senate Finance Committee in late February, nowhere in 16 pages of prepared remarks did Jonathan Blum specifically mention home care, home health or hospice. Nevertheless, those of us in the home health and hospice industries should be paying close attention to what the deputy administrator and director for the CMS Center of Medicare has been saying.

Nearly every reform effort he mentioned – from reducing hospitals readmissions to care coordination to fraud prevention — affects our industry in profound ways. Implementation of the Affordable Care Act already is changing how we determine eligibility, document care and receive payment. I’ve mentioned it before, but half of every dollar spent on healthcare in the United States goes to hospitals and doctors. Home health’s share? Just 3%.

Home health and hospice agencies have important supporting roles to play in many of CMS’s highest profile programs. The Hospital Readmissions Reduction Program has brought a decrease in all-cause readmissions of between 4% and 9%, Blum says, even though CMS is tracking only heart attack, heart failure and pneumonia.

And then there are various care coordination and payment reform efforts. More than 250 ACOs are providing services for more than 4 million Medicare fee-for-service beneficiaries in 47 states and territories. Let’s not forget the 32 Pioneer ACOs and the 35 Advance Payment ACOs that are exploring both care coordination and payment reform, Blum says.

CMS also is getting tough on fraud, with the new Fraud Prevention System that uses analytics to identify billing anomalies and the Automated Provider Screening system, which identifies ineligible providers.

I’ve said this before, too, but it bears repeating: Reform efforts represent a significant opportunity for the home health and hospice industries to shine. We have the home health technology, the industry expertise, the willing hands and the desire to help our patients stay at home, to get as healthy as their conditions allow, and to die with dignity if it’s their time.

Are you hunkering down and hoping all this reform effort passes? Or are you continually looking for opportunities to help hospital systems, physicians, health plans and others take better care of patients?

The choice is yours.

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