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MedPac’s Report to Congress

What is MedPac and why should you care?

Before I answer that question, I will admit that for years I thought MedPac was a Political Action Committee – you know, those huge organizations that use political contributions to try to win favor from lawmakers.  I was wrong.  Oops.  Or maybe it was just a bad name for the committee.

MedPac is a committee created pursuant to the Balanced Budget Act of 1997.  They are tasked with presenting information and recommendations to congress each year on payment to providers from Medicare.  There are eleven commissioners with impressive titles and yet they seem to know very little about the home health industry and show very little interest in learning.  I bet they are boring cocktail party guests if this lack of curiosity is pervasive.  Just yesterday, they posted their March report which, as always, includes chapter about Home Health payments.

It is a long and boring document so please allow me to share with you the highlights.  Here’s the big one.

MedPac recommends another five percent reduction to your payment and the elimination of therapy as a contributor to payment as we know it.

To support their position, various factoids taken out of context are posited as evidence.  They note, for instance, that most beneficiaries can leave the home to go to the doctor and yet, Medicare does not provide any incentives for beneficiaries to receive services elsewhere.

Just to be clear, a trip to the physician for an elderly patient with congestive heart failure, COPD, a surgical wound, a recent CVA, etc. is necessary on occasion.  In terms of difficulty, getting a cat to the vet is probably easier (although to their credit, Medicare beneficiaries don’t howl).  It can take the better part of a morning to help the patient bathe and dress.  Getting into the car is like directing an elderly person through a Cirque du Soleil rehearsal and upon arrival at the doctor’s office you might find that helping them out of the car makes getting into the car seem like child’s play.  Of course, all of this must be repeated in reverse after the office visit and elderly people who are confined to the home are often eager to have a meal out somewhere since they’ve already endured the torture associated with automotive travel.  Everyone is exhausted after the outing but it is worth it.  The patient gets medical care and the family spends some time providing their loved one with a good meal and company.  Passing a good time is not always easy.  MedPac doesn’t quite get that.

Having said that, lives would be in danger if this was a twice weekly occurrence and not just the patient’s life.  Even if a family had the will to survive such an ordeal several times a month, where would they take a patient for medication and diet teaching?  Does MedPac believe it would be less expensive to send a patient to the ER for IV medications?  About the only alternative I can think of is a skilled nursing unit or rehab facility that costs more and deprives the patient of the comforts of their home.

Patients requiring therapy often do go to outpatient therapy as suggested by MedPac, upon discharge from home health once the patient is no longer homebound.   We should not have to be the ones to inform MedPac of how this works.

The report talks about a 2015 CMS review of home care services that revealed that almost 60 percent of claims were missing information that satisfied Medicare criteria.  The report does not address all in the information sent to their contractors that is lost so neither will I.  I could but I won’t.  What’s important is the time frame of the report which resulted in an expansion of Medical review and the Preclaims Review Process.  MedPac uses cost report data that doesn’t not include the added expense of being under scrutiny or having to participate in the PCR process.  There are no home health leprechauns who put together charts and ensure that all the right pieces are put together so that the chart can be sent to the Medicare contractor that requested it. Paid employees do this work.

Another thought that occurs to me unbidden, as I hate to be unkind, is that when 60 percent of claims are found to be lacking one or more elements of documentation that satisfies Medicare requirements, maybe the problem is with the reviewer.  Maybe there should be more education available to providers.  Hell, I’d be happy if there were a number I could call and ask a question.  (CGS is excepted from this last comment.  Lately, I’ve been calling them for questions even though most of my clients bill Palmetto GBA).

There is so much more in this report that illustrates with utter clarity how little insight MedPac has into our industry but the therapy issue really gets under my skin like scabies.  MedPac believes the increase in therapy is not justified in the very same report that notes that hospitalizations in home health patients has decreased from 28.8 percent down to 25.4 percent.

Another way of saying that is that an increase in therapy visits coincided with a decrease in hospitalizations.  Even I know that correlation does not equal causation but MedPac presents no hard numbers to demonstrate that the lower hospital rates are not related to increased therapy although they speculate a little.

So, MedPac wants home health to take another hit.  Bully for them.

Back to the original question:  What is MedPac and why you should care?  The first part of that question has been answered.  More info is on their website if you are still curious.  The second answer is that this information is prepared for the US congress.  Unless they hear other points of view, our industry will continue to die a slow death by strangulation.  Our state and national associations have lawyers and lobbyists who can construct arguments with greater legal authority than most of us and I have no doubt that they will.  But if I were a senator or a representative (fat chance of that ever happening), I would want to hear directly from the people affected by these proposed cuts.  So, take a few minutes and let your congressmen know how very myopic and well, stupid this report is and suggest they put it in the recycle bin.  There’s no point in killing trees, too.

8 Comments Post a comment
  1. Mandy #

    This makes me want to vomit. Maybe if CMS would stop incentivizing the recovery audit contractors based on the dollar amount of denials, we would have a true, believable number of claims that have missing documentation instead of this over inflated 60 percent. Forcing home health agencies to meet arbitrary requirements doesn’t eliminate fraud. When will the people who matter understand this? Fraud and waste are committed by dishonest people. It doesn’t matter what the rules are, they will find a way around them.

    March 22, 2017

    • I see claims all the time denied because of a missing signature or a forgotten estimate of how much longer the patient would be on service. Consider your average agency. If it is time to pay staff and there is a critical piece of info unavailable, how likely is it that the agency will deny that week’s paycheck? Chances are they will just pick up the phone and call the employee. The bottom line is that they don’t want agencies to be paid.

      March 22, 2017
  2. Brandon Blake #

    PAC is payment advisory committee. More often than not (by a fairly sizable margin), Congress does not implement the recommendations by MedPAC.

    Brandon Blake

    March 23, 2017

    • I know that congress frequently ignores them. For years, the threat of a co-pay has hung over our heads. Still, it is insulting and the report was prepared for the congress and well, there is a lot of recent changes in Washington. So, regardless of past history, I still think we should tell our elected officials a different story.

      March 23, 2017
  3. Michelle #

    Just more examples of waste and abuse of resources by government. How much did it cost to assemble said report x 20 years…..

    April 5, 2017

    • The lack of insight is mind boggling, Michelle. The full report consists of chapters for each type of provider. Here’s the thing – They isolate each type of provider and use tunnel vision. It is true that the rate of cancer deaths is lower (13 percent from 2004 to 2013). So, if cancer deaths are lower, would it not stand to reason that deaths from Alzheimer’s are higher? MedPac seems to think that patients with Alzhiemer’s are figments of the fraudulent imaginations of hospice agencies. Try to admit them to home health and watch your claims get denied after one episode because you can’t fix Alzheimer’s.

      You can’t fix a lot of things but if Medicare put as much energy into educating home health and hospice agencies about care of the patient with Alzheimer’s, it would not only bring relief to the millions of people who suffer with Alzheimer’s or care for an afflicted family member, but it would likely save millions and millions of dollars.

      Oh, and while I am on my soapbox…. How about that diabetes? The direct costs of treating diabetes add up to 176 billion per year. Of that, 43 percent is payment to hospitals. If the direct costs were reduced by a mere 5%, that would be a savings of 3.5 billion per year. I would like to see home health up its game in care of patients with diabetes but even so…. imagine how many hospitalizations have already been prevented by good home nursing.

      So, MedPac keeps funneling the responsibility for caring for these patients down to home health and hospice and then says that we are over-utilizing. How does that work?

      April 27, 2017
  4. Sahily #

    I wonder how MedPac envisions our (HHA’s) future. I will quote you because I think you have just hit the nail in the head: “The bottom line is that they don’t want agencies to be paid”.
    They might as well just eliminate Home Health as an option for beneficiaries.

    April 10, 2017

    • Here’s what I dont’ understand. Across the spectrum of healthcare, the emphasis is to keep the patient away from the hospital where the most dollars are spent. When hospitals do that, they claim home health is overutilizing. You, my friend, are supposed to go into the home, fix the patient and be gone within an hour or two.

      If you fail to do that, you are regarded as a criminal. I know that being treated like a criminal doesn’t feel good to you but think about me – and it is all about me. All day, every day, I associate with criminals. Eventually, I’m going to knock over a liquor store or something just to fit in with y’all.

      April 27, 2017

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