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CMS to Modernize Medicare Home Health Care

Seniors on Medicare – particularly those who have home health care – may soon see significant new changes proposed for implementation by the Centers for Medicare & Medicaid Services (CMS).

On July 2nd, CMS announced that the proposed changes to the Home Health Prospective Payment System (HH PPS) will “strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care.”

In addition, the release stated, “Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update the payment model for home health care.”

That’s right, seniors. Medicare will soon see a new emphasis by CMS to place, as the organization calls it, “Value Over Volume” in handling their individual cases.

Because the new program was announced just recently, many seniors on Medicare may not yet know about it or its specifics. Here are some of the ways they’ll benefit:

  1. With more streamlined paperwork channels and treatment options, doctors, according to CMS, will have “more time to spend with their patients, allow home health agencies to leverage innovation and drive better results for patients,” said CMS Administrator Seema Verma. “The redesign of the home health payment system encourages value over volume and removes incentives to provide unnecessary care.”

  2. In doing so, the new program makes one major jump forward: it allows the cost of in-home health care (also known as “remote patient monitoring”) to be recorded and reported as allowable costs on the Medicare cost report form by home health agencies.

  3. By streamlining the paperwork, one of the hoped-for achievements of the new program is to develop and implement new technologies that can be utilized by home health agencies to have, according to the CMS media release, “more effective care planning, as data is shared among patients, their caregivers, and their providers. Supporting patients in sharing this data will advance the (Trump) Administration’s MyHealthEData initiative.”

  4. The new CMS program will also generate a new Patient-Driven Groupings Model (PDGM) that will cut the current 60-day period of care – as well as the number of therapy visits a patient receives during that period – to determine payment. Instead, the PDGM will completely do away with “therapy thresholds” and reduce the payment periods of care to 30 days.

  5. As such, by the time the PDGM is fully implemented by January 1, 2020, another goal is expected to be realized: to reduce HH PPS administrative time and effort.

  6. Also, physicians who order home health services for patients will see a marked reduction in the amount of time spent on administrative tasks they must perform. One thing of note: to eliminate the redundancy of a doctor estimating how long in-home skilled services may be needed for a patient when that same thing is already part of a patient’s plan of care.

  7. Here’s something everyone will be happy about: if the full proposed changes to the Home Health Quality Reporting Program are implemented as hoped, annual savings of $60 million to home health agencies will likely be realized, or roughly $5,150 per home health agency, starting in 2020. In addition, CMS’ previously announced Meaningful Measures Initiative, which is slated to be released at five different times during fiscal year 2019, is expected to save Medicare providers nearly four million hours of administrative time and close to $150 million in overall savings.

  8. Medicare recipients that are in the Skilled Nursing Facility Prospective Payment System will also see advancement and efficiencies in payments, services rendered, and paperwork requirements that potentially stand to save nursing facilities approximately $2 billion over the next 10 years.

  9. Lastly, according to CMS, Medicare Advantage patients are expected to have improved plans that would “offer more tailored plan benefit packages and new types of supplemental benefits.”

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