After Scathing Senate Report, Home Care Firms Fault Medicare Payment System

After a scathing report from the Senate Finance Committee showed that some private home health care companies were providing the most profitable number of therapy visits regardless of patient need, the industry is starting to react.

In a prepared statement, the National Association of Home Care and Hospice (NAHC) commended the Senate for calling to change the Medicare payment model.

“There have been systemic Medicare payment problems since its inception in 2000. Home health care has recommended that Medicare set payment rates based on the nature of the patient rather than the volume of services rendered, therapy or otherwise,” said Val J. Halamandaris, president of the National Association for Home Care & Hospice. “We have long been concerned that the current model discourages home health agencies from providing the care that was appropriate for the individual patient needs.”

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The Senate’s report found certain companies were pushing home visits on patients to reach the 10-visit threshold after which Medicare payments for the patient increase, generating extra revenue for the companies providing the care. Gentiva, one of the companies named in the report said it stands by its practices.

“Gentiva maintains its belief that the company is providing the highest quality of care and receives payment within the standards set forth by the reimbursement system established by the Centers for Medicare and Medicaid Services (CMS),” said the company in a statement.

The home care industry has recommended a series of legislative proposals that would remove the level and amount of therapy as a determent in payment.

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“Medicare’s proposed reforms may be viewed as a step in the right direction, but we believe that there are better ways to go than continued reliance on the number of therapy visits for determining the payment amount. We are somewhat concerned with the Medicare proposal that increases payments if the patient receives no therapy, while decreasing payments if they do,” said Halamandaris.

“Patients should get what they medically need, not what a payment model directs. Therapy is an essential service that helps patients return to independence, saving Medicare from higher costs while improving patients’ lives. There should not be incentives to deny patients’ care any more that than we should encourage unnecessary care utilization through a payment model,” he noted.

Written by John Yedinak

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