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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.

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