National Association for Home Care & Hospice (NAHC) members were visited by one of their staunchest allies this week at the 26th Annual Meeting in Denver as Sen. Susan Collins (R-Maine) received the association’s highest honor. NAHC’s “Mother Teresa Lifetime Achievement Award,” named for the now-beatified nun who dedicated her life to serving the poor and the sick in Calcutta, India, is given in recognition of exemplary and continuous service in the cause of caring for others.
“We have with us the strongest advocate for home care in the United States Senate,” said NAHC President Val J. Halamanderis. “You all know her -- you’ve seen her before at NAHC meetings and you’ve watched her advocate for you year after year.” He praised Collins’ efforts in the Senate to protect the elderly and infirm, adding that her work there is defined by her compassion and integrity.
“She’s someone that has lived her life with the idea of helping the American public as much as she humanly can,” said Halamandaris, welcoming Collins to the stage. “We are so pleased that she has adopted as her number one issue home care and hospice.”
Collins had kind words for the NAHC staff and members, commending their continued efforts to educate members of Congress on home care and hospice providers’ needs and ensure access to home care services. “Issues affecting home care and hospice have been at the top of my priority list since I first came to the Senate,” Collins said, “and it’s been my pleasure to work closely with this great organization on a variety of initiatives to modernize and promote fairness in the Medicare home health benefit.”
“The highly skilled services, the compassionate care that you provide each and every day, has helped to keep families together and enabled millions of our most frail and vulnerable older persons to avoid hospitals, emergency rooms, and nursing homes and stay just where they want to be -- in the comfort, the privacy, and the security of their own homes,” said Collins. She also noted that home care providers are of critical financial importance to the Medicare program, saving significant amounts of money by helping patients avoid care in costlier settings.
“I don’t know why the people in Washington don’t understand that this is true,” Collins said, adding, “It is so unfair that the Medicare home health benefit is once again under attack.” She pointed out that a version of the House of Representatives’ recent bill to reauthorize the State Children’s Health Insurance Program, or SCHIP, included billions in cuts to home health. “I’m worried that this issue has not died, and that both the House and the Senate could soon be considering home health cuts,” she said.
Meanwhile, making matters worse, the Centers for Medicare & Medicaid Services (CMS) has made administrative changes to address so-called case-mix “creep” under the home health prospective payment system that are soon to take effect and will significantly reduce reimbursements. “This would be a double-whammy for home care,” Collins contended.
“These cuts would be devastating,” she continued, “and, my friends, they are simply not right. This is certainly not in the interests of our nation’s seniors, who rely on home care to keep them out of hospitals, nursing homes, and other institutions.” Nor are such changes in the common-sense interests of the budget, according to Collins. “We see a direct correlation: when home health care is cut, emergency room visits go up,” she said. “That is costly, not to mention the human cost.”
Collins noted she will introduce legislation, the “Home Care Access Protection Act of 2007,” to prevent CMS’s changes to case-mix adjustment. It will be matched in the House with a sister bill from Claude Pepper Award winner Rep. James McGovern (D-Mass.). She called on NAHC members to help garner cosponsors of the legislation.
Collins contended that CMS has based its changes to the case-mix methodology on a flawed assertion. “The assertion is that home health agencies have intentionally gamed the system by claiming that their patients have conditions of higher clinical severity than they actually have in order to receive higher Medicare payments,” she stated. CMS found the changes necessary because its data showed that the average clinical assessment score of home health patients had increased, Collins noted.
However, the increase can be explained by legitimate clinical and policy reasons, the senator contended. “Let’s look at the facts,” Collins said. For example, hospital reimbursement methodologies “have led to the discharge of ever-sicker patients,” she pointed out, receiving a healthy round of applause from the audience. Also, advancements in technology and medical practice have allowed home health agencies to provide care for patients with more severe and complicated conditions, often at a reduced cost compared with other care settings, she said.
“It is so frustrating that there is no evidence of intentional gaming that would warrant such a severe financial penalty,” Collins said, characterizing the CMS action as misguided. “This unfair policy is being accessed across the board, even for home health agencies that have shown a decrease in their clinical assessment scores. Now, if an individual home health agency truly is gaming the system, CMS should target that agency,” Collins contended, again interrupted by a burst of applause.
“Home health as a share of Medicare spending has dropped from 8.7 percent in 1997 to 3.2 percent today,” Collins pointed out. “I think it ought to be going the other way.” She described the many strains and weak links in the health care system, and said home health care is “the future.”
“Home health care has consistently proven to be a compassionate, cost-effective alternative to institutional care,” Collins said. “Additional cuts would be counter-productive to our efforts to control overall health care spending.”
In addition to helping gather support for the case-mix fix legislation, Collins said attendees should continue urging their members of Congress to sign on to letters calling for no further cuts to home health and hospice and to preserve their full market basket updates.
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