The comment period for a new Centers for Medicare & Medicaid Services (CMS) rule has wrapped up and the consensus among commenters is that it missed the mark. This is because the rule, the Home Health Prospective Payment Rate, would cut payments by more than $800 million in 2023.
The rule, which is coming on the heels of new drug price negotiation capabilities and out-of-pocket prescription drug caps in the Inflation Reduction Act, has had an outpouring of responses, with 691 industry stakeholders weighing in. The comments indicated that the increase in access and funding for home health care during the pandemic is preferable for patients and allows providers to keep up with the soaring costs of both material goods and staff.
“What is particularly disheartening about the proposed rule is home health is one of the least costly settings and is often the preferred settings for patients, and yet Medicare is choosing this moment [to] disinvest in it, when others are choosing to double in home-based care.”
National Association for Home Care & Hospice (NAHC) president William Dombi said that his organization tried to replicate the information CMS provided in their rule, but says that CMS didn’t and wouldn’t provide the full set of information necessary to do so. He followed the same train of thought as Mass General Brigham had, noting that the new rule seemed to be working against some of the goals of CMS.
“CMS is betting on the success of a Home Health Value-Based Purchasing Model expansion nationwide to garner almost $3.5 billion in Medicare savings through reduced hospitalizations and the like. Yet they’re pulling resources away from home health agencies to reach those goals. It seems so counterproductive what CMS is doing in cutting payment rates, increasing costs and undervaluing the inflation that all of health care is going through.”
Dombi’s organization sent in their strong criticism directly to CMS, but have also been working legislative angles, discussing bills like the Preserving Access to Home Health Act, which has been introduced in some form to both the House and Senate by pairs of opposite-party representatives. He believes that Congress may be able to protect home health if CMS continues forward with the proposed rule.
Many hospital systems that work with home health organizations already struggle with providing the best value-based care because prior or even ongoing patient documentation arrives in the EMR as an image file. It’s one thing to be able to at least label the documents within a patient’s file, but there’s a whole world of value-based care to be unlocked when their discrete data resides in their electronic medical record. Access to this data gives clinicians the opportunity to enact preventative maintenance plans that are less expensive and provide better outcomes than waiting to find a disease (this is also a goal in other parts of healthcare, as in Mayo Clinic and Mercy’s data sharing agreement).
So when these unstructured faxes, image files, and paper come flowing into an office, it’s up to healthcare organizations to extract the data to provide the best outcomes. Oftentimes, this is done by hiring more staff, but unpredictable times and inconsistent document volumes make that difficult.
Outsourcing is another option, although it’s really just shifting where the labor takes place. You still need all the data entered, but now your data is travelling and someone else is entering it.
You could also use just a handful of your expert staff to get the data matched and entered using an automation software like Extract’s HealthyData. Everything stays behind your firewall and our implementations generally free up about half of an organization’s data entry staff for higher value tasks.
If this sounds like something you’d be interested in, please reach out and we’ll be happy to explain how it works with an email, phone call, or demonstration of the software.
About the Author: Chris Mack
Chris is a Marketing Manager at Extract with experience in product development, data analysis, and both traditional and digital marketing. Chris received his bachelor’s degree in English from Bucknell University and has an MBA from the University of Notre Dame. A passionate marketer, Chris strives to make complex ideas more accessible to those around him in a compelling way.