Alarming News from CMS

Last week, the Centers for Medicare and Medicaid Services released the final home health Medicare payment rule for calendar year 2023. The news is alarming.

The rule temporarily blunts the immediate impact of the original proposal for a “permanent adjustment” (cut) but leaves it intact. A plan to claw back payments dating back to January 1, 2020 (a “temporary adjustment”) is still being considered. 

Put another way, at a time when home health and hospice agencies are responding to double digit inflation for wages, benefits and transportation, CMS is proposing to cut rates and keep Medicare spending on home health services nearly flat. The new rule represents only a 0.7% increase in aggregate spending. 

Specifically, the proposed rule called for a devastating permanent 7.65% reduction to base Medicare payment rates. The final rule increases the cut to 7.87% and implements half the cut in 2023 (3.925%) and the full cut in 2024. Net home health payments are based on a number of factors including the base rate, an inflation factor (which increased in the final rule) and a wage index among other elements. When taken together, the net impact in Vermont will be a 1.8% cut for rural agencies and a 1.2% cut for urban agencies on January 1, 2023. 

“This rule offers the tactic of relief for CY 2023, but this short-term acknowledgment that home health cannot withstand devastating cuts does nothing to address the long-term impacts . . . on the stability of the Medicare home health program and services to senior citizens” said Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare. 

Home health agencies across the country have urged their congressional delegations to step in and support the Preserving Access to Home Health Act. Vermont Senator Patrick Leahy is a co-sponsor of the Senate version of the bill and Congressman Peter Welch is a co-sponsor of the House version. 

In response to the release of the final rule, William A. Dombi, President of the National Association for Home Care & Hospice said, “We now turn to Congress to correct what CMS has done and prevent the impending harm to the 3.2 million highly vulnerable home health patients that depend on this essential Medicare benefit annually. Even with the limited phase-in of the rate cut, with significantly rising costs for staff, transportation, and more, home health agencies across the country cannot withstand the impact of rate cuts. 

Physical Therapy in the Home

Last month was National Physical Therapy Month, a time to raise awareness with consumers about the many benefits of physical therapy and also to appreciate what PT professionals do to change lives. Many people don’t think about the fact that home health care includes physical therapy. Indeed, it is an important part of moving acute care patients, like post-operative clients, back to autonomy and to helping long-term care patients remain independent.

We talked to physical therapist Jenn Quinn of Addison County Home Health and Hospice about what led her to home care PT and why she considers it the perfect place of service for her.

“I think treating someone in their home is the most applicable environment to their real life,” Jenn relates. “Working on stairs in a clinical setting is great, but doesn’t necessarily translate to [the patient] being able to use the stairs in their home. For us to be able to provide care in the place where a person lives and functions is truly unique and the most effective place to treat the patient.”

She notes that because patients are inviting home health staff into their homes, caregivers develop special relationships, particularly when patients are most vulnerable. 

“We feel it’s an honor to go into patients’ homes. We really do think of it as an invitation and that is something we respect,” she adds.

When asked what led her to her current career in home health, Jenn says she feels lucky to have found out how rewarding it can be.

“I started my job as a PT in a rehab facility, and I loved that,” she explains. “By chance, one of my fellow clinicians left to do a home health job and enticed me to go with her. I’m so grateful that I did. As soon as I started in-home care, I realized I could never work anywhere else,” she stresses.

She says she doubts people realize all the different hats home care PTs wear. 

“Sometimes to obtain the most effective results, we have to step out of our PT box a little bit,” she muses. “Some days, we might need to be a social worker, some days, a nurse assessing a wound, some days, part occupational therapist—all to give care the way patients need it. It’s challenging, but also pretty special, and it keeps it interesting!”