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Home care groups fight for update

Home healthcare providers are ready to fight to retain an expected update in Medicare's reimbursement for its services.

While the increase, termed an inflationary adjustment, has strong support in Congress, home health industry groups were still waiting to hear final word late last month.

Other payment issues, including a refined prospective pricing system for home health services, are looming concerns for the industry, said Ann Howard, director of federal policy for American Association for Homecare.

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The industry also is awaiting details of an initial test of a pay-for-performance demonstration project for home health. Mark Wynn, director of the division of payment policy demonstrations in CMS' Office of Research, Development and Information, said CMS would soon begin work on details of a home health pay-for-performance test case.

But the main concern is ensuring that the expected 3.1 percent inflation adjustment goes into effect on January 1, Howard said. The fear is that pressure from other healthcare provider groups to address payment reductions related to the Deficit Reduction Act of 2005 might prompt a last-second change in the increase.

That's because a planned inflation adjustment for this year was retroactively eliminated, she said.

 "We'll fight tooth and nail on it. We're working to educate and make sure that Congressional offices know the importance of the adjustment," Howard said.

The increase is even more critical as home health agencies face mounting pressure to increase their use of information technology. That's an expensive investment for most agencies.

Home health providers also were awaiting a final rule specifying refinements in the prospective pricing system that's been implemented to pay for home health services. The organization expects changes in the way agencies are reimbursed for medical supplies and an end to the single-therapy threshold, which caps payment to agencies if they provide more than 10 therapy visits.

Howard said the home health segment is ready for a pay-for-performance plan. CMS posts 10 outcomes measures for individual home health providers on its Web site; those measures include outcomes such as keeping patients out of the hospital and in the community rather than in a long-term care setting.

"Our members are not feeling great angst about pay for performance," she said. "Whether they welcome it or don't welcome it, they know that (a pay-for-performance plan for home health) is probably going to happen."