Home Healthcare Cuts.....

[MMC]

More bad news for Team O and his care package. :shock: AMAC is telling people about this now......plus how it affects jobs. They are saying BO care is the cause. They sure aint waiting a long to start bringing this stuff out, are they. What say ye?

President Obama's mendacious political promise, "If you like your health care plan, you can keep it," continues to cast a long and disturbing shadow of doubt and confusion over millions of Americans who have lost coverage as a result of Obamacare. As 2014 unfolds, the most vulnerable senior citizens — those who receive home health care services — are about to learn they are out of luck. Obamacare opens a trap door under them, leaving this elderly population in freefall — with many citizens losing access to home health care.

Add another compelling reason to reverse Obamacare. Whether by accident or intention, the "Affordable Care Act" empirically strips America's oldest and poorest cohort, all part of the World War II generation, of this basic coverage. Here is how.

On Jan. 1, Medicare's home health care services, formerly serving 3.5 million elderly beneficiaries across the country, were cut under Obamacare. The cut deleted exactly 14 percent, or an estimated $22 billion, from these lowest-income Americans over four years. News of the forthcoming cut only trickled out the Friday before Thanksgiving, yet another stunning attempt by the Obama White House to reduce Medicare benefits without attracting notice.

Guess what? We noticed. This cut does irreparable damage to recipients of Medicare's home health care services, those who are aged, homebound and sicker than the average Medicare population. Indeed, nearly two-thirds of Medicare home health care users live at or below the federal poverty level, meaning they are the most economically compromised of America's precious senior citizens.

This cut is an indictment of White House policies. Home health care agencies have always provided services to homebound Medicare beneficiaries. No hoopla, but when these Americans needed skilled care, they got it. In contrast to expensive hospital care, critical health care services got into millions of American homes via clinicians. Home health care was — and still is — vital. It is also now effectively gone for these Americans.

How did home health care save money for taxpayers? Using 2009 as a reference year, Medicare's average Part A and Part B payment for a home health care visit was $145, compared to $373 per day in a skilled nursing facility or a whopping $1,805 per day in a hospital. In addition, according to one leading expert, skilled home health care services saved the Medicare program $2.8 billion during the most recent three-year period. Approximately $670 million of that savings is attributable to 20,000 fewer hospital readmissions.

Given these facts, one would conclude that the value of home health care in driving down Medicare costs should be obvious, if this — and not a single-payer system — were the real goal of Obamacare. How did we lose sight of common sense? Just keep patients in a familiar surrounding — their homes, not in an expensive hospital — keep sound disease management programs that deliver better and more cost-effective outcomes, and continue to coordinate care for patients. That was working. Now we have the reverse — markedly higher medical and insurance costs, with absolutely no institutional connection, support or continuing benefits for these especially needy Americans, the ones who depended — with their families — on critical home health care benefits. The president and his Democratic surrogates in the House and Senate have done it again: They have wiped out another critical, working system with this Obamacare monstrosity.

>What else will this home health care cut achieve? It will hit the small businesses that provide home health care nationwide, and is already doing so. More than 90 percent of those providing home health care are small businesses. According to the U.S. Center for Medicare and Medicaid Services, 40 percent of these companies will be operating "at a loss" — that is, they will likely fold or end up in bankruptcy — by 2017 as a result of the cut. What does that mean? It means nearly 5,000 more Medicare home health care providers may go out of business, and nearly 500,000 more jobs within this flogged industry may be wiped out to fund Obamacare. Those who care about such things should put that into their future unemployment calculations — and then thank Mr. Obama and his congressional friends, who all got a waiver and probably do not worry about home health care anyway.....snip~

http://townhall.com/postrelease.html?prx_adv=&prx_t=94312959&prx_q=2922

 

[CalGun]

Shhh...we can't talk about that till next January...shame on you

 

[MMC]

Shhh...we can't talk about that till next January...shame on you

Yeah but it counts loss of jobs to come. Which should be tied to BO when he is talking about the economy.

That's another industry that will be reduced to nothing.

 

[Greenbeard]

From the Medicare Payment Advisory Commission's March 2013 Report to Congress:

Medicare has always overpaid for home health services under PPS.

Payments for home health care have substantially exceeded costs since Medicare established the PPS [the lump sum, paid in two installments, health home agencies get for each 60-day episode]. In 2001, the first year of PPS, margins equaled 23 percent. The high margins in the first year suggest that the PPS established a base rate well in excess of costs. The base rate assumed that the average number of visits per episode would decline about 15 percent between 1998 and 2001, while the actual decline was about 32 percent (Table 9-12,p. 206). By providing fewer visits than anticipated, HHAs were able to garner extremely high average payments relative to the services provided.

Margins have stayed high since 2001 because annual increases in payment have exceeded growth in costs. The Commission’s review of the annual change in cost per episode suggests that cost growth has been minimal, typically less than 1 percent. In some years, a decline has been observed. Average payments per episode have generally increased from year to year, driven by market basket increases and increases in the average case-mix index.

This structural mismatch between payment levels and cost growth led to the Commission recommending in March 2010 that Medicare rebase payments to be closer to costs (Medicare Payment Advisory Commission 2010). PPACA has mandated some reductions for home health care that begin to reduce payments, but these reductions would leave HHAs with margins well in excess of cost. Overpaying for home health care has negative financial consequences for the federal government and the beneficiary; implementing the Commission’s prior recommendation for rebasing would better align Medicare’s payments with the actual costs of HHAs.

 

[ttwtt78640]

The trend, favored by the left, seems to be taking ever more from the eligibility based on contribution entitlements (SS/Medicare) in order to transfer those funds to the eligibility based on financial need entitlements (SNAP/Medicaid/PPACA). This seems to be the jist of "social justice" - from each according to their ability (to pay taxes), to each according to their need (for free stuff).

 

[MMC]

From the Medicare Payment Advisory Commission's March 2013 Report to Congress:

From AMAC APRIL 6th 2014......a year and a month later.

4/6/2014 12:00:59 AM

The cut deleted exactly 14 percent, or an estimated $22 billion, from these lowest-income Americans over four years. News of the forthcoming cut only trickled out the Friday before Thanksgiving, yet another stunning attempt by the Obama White House to reduce Medicare benefits without attracting notice.

Indeed, nearly two-thirds of Medicare home health care users live at or below the federal poverty level, meaning they are the most economically compromised of America's precious senior citizens.

What else will this home health care cut achieve? It will hit the small businesses that provide home health care nationwide, and is already doing so. More than 90 percent of those providing home health care are small businesses. According to the U.S. Center for Medicare and Medicaid Services, 40 percent of these companies will be operating "at a loss" — that is, they will likely fold or end up in bankruptcy — by 2017 as a result of the cut. What does that mean? It means nearly 5,000 more Medicare home health care providers may go out of business, and nearly 500,000 more jobs within this flogged industry may be wiped out to fund Obamacare.....snip~

Now that helps those out in rural and country areas.....how? Loss of jobs too.

 

[Greenbeard]

From AMAC APRIL 6th 2014......a year and a month later.

The key point isn't the date, it's the fact that home health reimbursements under PPS have never tracked the actual costs of delivering the services. Reimbursements have gone up even when the industry's actual costs have gone down. Common sense changes are common sense.

 

[MMC]

The key point isn't the date, it's the fact that home health reimbursements under PPS have never tracked the actual costs of delivering the services. Reimbursements have gone up even when the industry's actual costs have gone down. Common sense changes are common sense.

It is the point of the date.....and due to the info being released Right before Thanksgiving of 2013. Over 6 months later than the report made to Congress.

 

[Greenbeard]

It is the point of the date.....and due to the info being released Right before Thanksgiving of 2013. Over 6 months later than the report made to Congress.

And? The ACA gives HHS authority the make cuts of up to 3.5% per year. MedPAC, in noting that payments to home health suffer from a structural mismatch between reimbursements and costs (the taxpayers are overpaying), suggested that the maximum ACA cuts aren't enough.

PPACA has mandated some reductions for home health care that begin to reduce payments, but these reductions would leave HHAs with margins well in excess of cost.

And in fact in issuing the rule on the cuts to home health, HHS noted that the data suggested HHS should be cutting reimbursements by 3.6% per year but since it's only allowed under the ACA to cut by up to 3.5% they settled on that.

1. Rebasing the National, Standardized 60-Day Episode Payment Amount

In the proposed rule, we estimated that the 2013 average cost per episode was $2,559.59. The 2013 estimated average payment per episode was $2,963.65. When comparing the 2013 costs to 2013 payments, we obtained a difference of -13.63 percent, or a reduction of 3.60 percent over four years in equal increments using a compound annual growth rate (CAGR) formula (($2,559.59/$2,963.65) ^1/4 - 1). Since the Affordable Care Act states that the adjustment(s) may be no more than 3.5 percent in a given year, we proposed a reduction to the national, standardized 60-day episode rate of 3.50 percent in each year from CY 2014 through CY 2017.

 

[ttwtt78640]

From the Medicare Payment Advisory Commission's March 2013 Report to Congress:

Also taken from your link (page 208):

Patients who need therapy may see some decline in access, but these services would be available on an outpatient basis after the home health episode ended.

This assumes that those now getting in-home care are also quite capable of accessing outpatient care - if that were the case then why not eliminate, instead of reduce that care by 14%?

The bottom line is that MPAC has but one major mission - to transfer Medicare funds to PPACA.

 

[MMC]

And? The ACA gives HHS authority the make cuts of up to 3.5% per year. MedPAC, in noting that payments to home health suffer from a structural mismatch between reimbursements and costs (the taxpayers are overpaying), suggested that the maximum ACA cuts aren't enough.



And in fact in issuing the rule on the cuts to home health, HHS noted that the data suggested HHS should be cutting reimbursements by 3.6% per year but since it's only allowed under the ACA to cut by up to 3.5% they settled on that.

And.....and those Jobs and industry will be sacked. And.....this will affect all those poor people in rural and country areas. And the fact they took the money to make BO care feasible.....as its still not really working. Backend and all.

 

[Greenbeard]

This assumes that those now getting in-home care are also quite capable of accessing outpatient care - if that were the case then why not eliminate, instead of reduce that care by 14%?

That's a reference to a specific recommendation MedPAC is making in that report ("The Secretary should revise the home health case-mix system to rely on patient characteristics to set payment for therapy and nontherapy services and should no longer use the number of therapy visits as a payment factor."), not a reference to the policy being discussed here.

 

[ttwtt78640]

That's a reference to a specific recommendation MedPAC is making in that report ("The Secretary should revise the home health case-mix system to rely on patient characteristics to set payment for therapy and nontherapy services and should no longer use the number of therapy visits as a payment factor."), not a reference to the policy being discussed here.

What, other than patient characteristics, would dictate the number of therapy visits now? My concern (fear?) is that some "genius" on an advisory panel will now decide that a "typical" broken bone will require X (pick a number) therapy visits but a patient needing (and thus getting) less (or more) therapy visits will then get exactly X visits.

Of course, the therapy provider would expect to be paid for each visit just a plumber, electrician, auto mechanic or any other trade charges based on time and material for that individual job not a fixed price based on what the customer reported as being the "typical" problem. Imagine a tradesman saying "sorry maam/sir but I was allotted 46.3 minutes to make that particular repair and. since my time is up, I must go, btw that neither reduces your bill nor have I competed the repair".

 

[Greenbeard]

What, other than patient characteristics, would dictate the number of therapy visits now? My concern (fear?) is that some "genius" on an advisory panel will now decide that a "typical" broken bone will require X (pick a number) therapy visits but a patient needing (and thus getting) less (or more) therapy visits will then get exactly X visits.

The good thing about MedPAC reports is that they provide all the context and rationale needed to understanding current Medicare payment policy and their recommended changes.

For this issue, they do that on page 197 of the report.

Volume of therapy services is influenced by incentives in Medicare’s payment system

The number of therapy visits a beneficiary receives during a home health care episode is one of the factors that determines Medicare’s payment for a home health episode. Generally, providing more therapy visits raises the episode payment. The Commission has long had a concern that allowing actual utilization to drive payment creates an incentive for agencies to provide more services to increase payment, and changes in episode volume have generally reflected the incentives for therapy payment in the payment system. The Commission recommended that Medicare redesign the payment system to rely solely on patient characteristics, and not the number of services provided, for setting payment, but CMS has yet to implement this recommendation (Medicare Payment Advisory Commission 2011).

A review of historical trends in the volume of therapy services indicates that payment incentives significantly influenced provider behavior. From 2001 to 2007, CMS had a single payment adjustment for therapy that increased payment for episodes with 10 or more therapy visits. In this period, the growth rate for episodes that just met the threshold was almost double the growth for all other home health episodes. This trend led to concerns that providers were deliberately targeting the 10-visit threshold.

Responding to these concerns, CMS implemented changes in 2008 that lowered payments for episodes with 10 to 13 therapy visits and increased payments for episodes in the 6 to 9 and 14 or more therapy visit ranges. The subsequent changes in therapy utilization reflected the new incentives: Episodes with 10 to 13 therapy visits decreased 27 percent, while those with 6 to 9 therapy visits and 14 or more visits increased by 43 and 27 percent, respectively (Figure 9-3). This was the largest one-year shift in therapy volume since the PPS was implemented. Since 2008, the growth in episodes has followed this pattern, with episodes with 14 or more visits growing significantly.

Pay for more, get more. One of the most serious flaws of the current payment system.

 

[ttwtt78640]

The good thing about MedPAC reports is that they provide all the context and rationale needed to understanding current Medicare payment policy and their recommended changes.

For this issue, they do that on page 197 of the report.



Pay for more, get more. One of the most serious flaws of the current payment system.

This payment system flaw exists in many "safety net" programs that are based on the federal poverty level; earn less working or add dependents and you get more benefits.

The logical fallacy, of course, is that making a broken leg get funding for X therapy visits also means that those patients needing less than X therapy visits still means waste, while those patients needing more than X therapy visits will be cutoff after X visits.

Providers are not going to offer free care because that is "the right thing to do". If you pay me to build 60 feet of fence then I don't care if the line to be fenced is 40 feet long, 60 feet long or 80 feet long - you will get the same material and labor sent to do the job.

 

[MTAtech]

Another hit job. Conservatives want medical costs to drop but complain when payments fall. You can't have a drop in the cost to the government and also the government paying the same fees.

Also, reducing reimbursements to medical providers doesn't cut care for patients. Medical providers are contractually obligated to accept what is paid.

 

[MMC]

Another hit job. Conservatives want medical costs to drop but complain when payments fall. You can't have a drop in the cost to the government and also the government paying the same fees.

Also, reducing reimbursements to medical providers doesn't cut care for patients. Medical providers are contractually obligated to accept what is paid.

:lol: Yeah AMAC is out to do a hit job. Now that's a good one. :lamo

 

[Greenbeard]

This payment system flaw exists in many "safety net" programs that are based on the federal poverty level; earn less working or add dependents and you get more benefits.

The logical fallacy, of course, is that making a broken leg get funding for X therapy visits also means that those patients needing less than X therapy visits still means waste, while those patients needing more than X therapy visits will be cutoff after X visits.

Providers are not going to offer free care because that is "the right thing to do". If you pay me to build 60 feet of fence then I don't care if the line to be fenced is 40 feet long, 60 feet long or 80 feet long - you will get the same material and labor sent to do the job.

Fee-for-service isn't a "safety net" issue, it's the basis of most public and private insurance programs. It incentivizes volume and fails to take into account the quality of the service provided.

Pay for additional widgets, get additional widgets wether you need them or not. Then watch providers blame "defensive medicine" for huge volumes of unnecessary care they're getting reimbursed for.

 

[ludin]

Another hit job. Conservatives want medical costs to drop but complain when payments fall. You can't have a drop in the cost to the government and also the government paying the same fees.

Also, reducing reimbursements to medical providers doesn't cut care for patients. Medical providers are contractually obligated to accept what is paid.

I guess you failed to read the part where it is cheaper to have in home care about 200 a visit compared to hospital/outpatient care at about 400 a visit.
that doesn't include them getting there which means they either have to have a friend or family member take them.

so instead of wanting them to spend less money (in home care) they have to spend more money (hospital/outpatient) and on top of that the cost and trying to find someone to take them.

yes the only way that someone can say that this is a hit job is using the typical left wing logic.

 

[ludin]

Fee-for-service isn't a "safety net" issue, it's the basis of most public and private insurance programs. It incentivizes volume and fails to take into account the quality of the service provided.

Pay for additional widgets, get additional widgets wether you need them or not. Then watch providers blame "defensive medicine" for huge volumes of unnecessary care they're getting reimbursed for.

that isn't how defensive medicine works.

Defensive Medicine: A Cure Worse Than The Disease - Forbes

 

[Greenbeard]

that isn't how defensive medicine works.

That's how the defense for collecting payment for (admittedly!) unnecessary services works.

 

[ttwtt78640]

Fee-for-service isn't a "safety net" issue, it's the basis of most public and private insurance programs. It incentivizes volume and fails to take into account the quality of the service provided.

Pay for additional widgets, get additional widgets wether you need them or not. Then watch providers blame "defensive medicine" for huge volumes of unnecessary care they're getting reimbursed for.

Fee for service is common in all sorts of businesses, including mine (home repair/improvement). Judging the "quality" of service in many cases is impossible. E.g. building a fence depends on the length, height, lot shape, number/size of gates and materials used - the charge is therefor variable and in no way related to averages. The same is true even of mowing a lawn (even of the same size) - the time required for trimming around obstacles and the cleaning of clippings off of paved surfaces makes a difference.

Using my prior example of therapy after a broken bone is set/healed, the amount of therapy sessions depends more on the condition of the patient before the break, the patient's weigh, build, age, gender and their natural level of physical activity than on the quality of the prior bone healing treatment given. It is simply wrong to expect each case to be "average" and thus require the same number of therapy sessions. Rest assured that a therapist expects to be paid for each treatment given not for each patient assigned to them regardless of the number of sessions required.

 

[ludin]

Fee for service is common in all sorts of businesses, including mine (home repair/improvement). Judging the "quality" of service in many cases is impossible. E.g. building a fence depends on the length, height, lot shape, number/size of gates and materials used - the charge is therefor variable and in no way related to averages. The same is true even of mowing a lawn (even of the same size) - the time required for trimming around obstacles and the cleaning of clippings off of paved surfaces makes a difference.

Using my prior example of therapy after a broken bone is set/healed, the amount of therapy sessions depends more on the condition of the patient before the break, the patient's weigh, build, age, gender and their natural level of physical activity than on the quality of the prior bone healing treatment given. It is simply wrong to expect each case to be "average" and thus require the same number of therapy sessions. Rest assured that a therapist expects to be paid for each treatment given not for each patient assigned to them regardless of the number of sessions required.

yeah I don't know any business at least in the service industry that has set prices for everything.

I use to do quotes for a home automation company and all of my costs varied depending on the house being done. a 3k sqft house with standard 8 foot ceilings was cheaper than a 3k sqft house with 10ft ceilings. or even a 4k sqft home with 8 ft ceilings.

all costs were varied on that.

 

[sangha]

yeah I don't know any business at least in the service industry that has set prices for everything.

I use to do quotes for a home automation company and all of my costs varied depending on the house being done. a 3k sqft house with standard 8 foot ceilings was cheaper than a 3k sqft house with 10ft ceilings. or even a 4k sqft home with 8 ft ceilings.

all costs were varied on that.

I'm in the service business. My rates are set

Banks are in the service business. Their rates are set.

My cell phone service provider is a service business. Their rates are set.

All sorts of service businesses have set rates. You don't seem to know much about the service business.

 

[ttwtt78640]

yeah I don't know any business at least in the service industry that has set prices for everything.

I use to do quotes for a home automation company and all of my costs varied depending on the house being done. a 3k sqft house with standard 8 foot ceilings was cheaper than a 3k sqft house with 10ft ceilings. or even a 4k sqft home with 8 ft ceilings.

all costs were varied on that.

Yep. The gov't wants to pay for "repair of broken tibia" at a set rate - but that is not necessarily the same "job" on a spry 20 year old man as a worn out 80 year old woman. I assume that they see the law of averages coming into play to "even it out" but that assumes a very large and continuos flow of patients with the same ailment. If you happen to do this treatment only three times in a given year and all of your patients are old then you get screwed. This is why many care providers are opting out of taking Medicaid and Medicare patients.