Why a Medicare payment change is causing home health agencies to cease services

A change to how Medicare pays for home health services has led to some agencies ending services for beneficiaries, according to The Washington Post.

Six things to know:

1. On Jan. 1, payment for home health services provided to people with traditional Medicare became based on new criteria under the Patient-Driven Groupings Model. The model bases payment on underlying diagnosis, other medical complications, level of impairment, type of referral and timing of services.

2. Before the new reimbursement system took effect, Medicare home health rates reflected the amount of therapy delivered. Under the previous model, more visits usually meant higher payments.

3. The new reimbursement model may incentivize home health agencies to serve patients with short-term therapy post-hospital or post-rehabilitation, some experts told The Washington Post. Providers may see fewer incentives if they treat patients requiring extensive physical and occupational therapy.

4. When the National Association for Home Care and Hospice asked 1,500 agencies in fall 2019 how the reimbursement change would affect their operations, a third said they would reduce therapy services across the board.

5. In addition to service cuts, agencies are reducing their therapist workforce. Some agencies are also asking workers to decrease their number of visits and provide care for under 30 days, according to the Post.

6. In an email to the Post, a CMS spokesperson said it is monitoring the model's rollout and doesn't "expect home health agencies to under-supply care or services; reduce the number of visits in response to payment; or inappropriately discharge a patient receiving Medicare home health services as these would be violations of [Medicare] conditions of participation."

Learn more about the new model here.

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