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MedPAC Flags Home Health Referral Problems

Posted on Friday, June 22, 2018 7:04 PM

The Medicare Payment Advisory Commission (MedPAC) report that was released on June 15, 2018 includes refinements to their proposed unified post-acute care prospective payment system and for greater patient usage of high quality post-acute care providers.

The refinements to a unified post-acute care prospective payment system would help to increase the accuracy of Medicare payments for post-acute care.  MedPAC is recommending implementation of the new system in 2021.

The report reads: “higher profitability for later home health stays suggest the need for an adjustment to payments based on the timing of the stay to more closely align payments with costs. Otherwise, (HHAs) could generate additional profits by referring beneficiaries for additional home health care, assuming the beneficiary continued to meet coverage rules.”

The report also discusses MedPAC’s concern that when patients are discharged from hospitals they rarely choose the top-rated home health providers and often choose one of the worst. 

According to the report, 94 percent of home health beneficiaries do not choose the highest-quality provider and about 70 percent have at least five home health providers within a 15-mile radius with higher quality care than the one they choose.

What’s more, the differences in quality between the agencies are often quite stark. “The magnitude of the quality difference between the higher performing nearby providers and the provider selected was substantial in many cases,” noted MedPAC in its report.

While choosing the best provider is a top consideration, the National Association for Home Care & Hospice notes that other factors – such as convenience, and cultural issues, like language, are also properly considered by patients when choosing a provider. MedPAC concedes this point in its report.

Click here for the full report.

Source: NAHC Report

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