Reinventing Home Health?

“(T)he Affordable Care Act directs CMS to develop a plan to implement value-based purchasing…encouraging home health agencies for some time to partner with ACOs (Accountable Care Organizations) and become part of the value stream.

Yet beyond dabbling in a handful of bundled payment experiments, few home health care companies have made an effort to be part of the discussion about value-based care. Not a single one has taken the lead.

One reason for their reticence is an issue of comfort: like most other established businesses, they resist change.

Another, perhaps less emotional reason, is the way that CMS issued its final rule on ACOs. Home health providers can be part of a Medicare ACO at its inception as long as a physician group or hospital is the primary owner. Beyond that, any other arrangement by another Medicare provider or supplier must be approved at the discretion of the Secretary.

Further, since agreements and contracts must be executed before an ACO submits its application, it isn’t clear whether that new agreement would be allowed at the beginning of a new performance period.

What the VBR (Value-Based Reimbursement) initiative means for home health agencies is clear and is part of CMS’ stated objectives: weaker providers without the technology and other means to keep costs in line and quality under control will go out of business. There are more than 12,000 Medicare-certified home health agencies today. Perhaps less than half will survive in the form we know it by 2018, with the fastest decline in pilot states.

Innovations In Home Care

Some providers are looking beyond traditional service models and expanding their services to enhance the patient experience, improve the quality of care, and lower costs:

  • Hospice of Michigan last year expanded its At Home Support program to partner with Ohio-based Western Reserve, after a pilot showed a 34 percent cost reduction—about $3,400/month—by reducing hospitalization, re-hospitalizations, and emergency room (ER) utilization.
  • Moorestown, New Jersey-based BAYADA Home Health Care has launched a physician house call service that it expects will enhance the continuum of care offerings the company already provides. The company made news with a substantial technology investment in April 2013, when it equipped 4,000 caregivers with Samsung Galaxy tablets. BAYADA says it improved patient care, allowed for faster reimbursement, and reduced after-hours paperwork.
  • CMS recently announced results from the first performance year of its Independence at Home project, calling the demonstration “positive and promising.” Evaluators found that participants saved over $25 million — on average, about $3,070 per beneficiary. CMS said all 17 participating practices improved quality in at least three of six quality measures and four practices improved quality on all six. One of the program participants, the Visiting Physicians Association, netted $7.8 million in practice incentive payments out of the $11.7 million bonus that CMS paid out.” – Reinventing Home Health?
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