THERE HAVE BEEN many battles on the community care front in 2008. Some are still unsettled, but for now things have slowed down.
Just before the turn of the year, the Medicare, Medicaid and SCHIP Extension Act of 2007, unanimously approved by the Senate and approved by two-thirds of the House, replaced a scheduled cut to the Medicare physician reimbursement rate in 2008 with a one-half percent increase through June 30.
“Fifty percent of physician practices have less than five physicians, and yet account for 80 percent of outpatient visits,” said Cecil Wilson, MD, a member of the board of trustees for the American Medical Association. “Steep payment cuts under the (current payment method), along with numerous other challenges in the current healthcare environment, threaten the continued viability of these practices.”
Physicians can rest easy for another year. On July 15, Congress approved the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), with enough votes to override President Bush’s earlier veto. The act reversed the 10.6 percent cut, stalled any further cuts until January 2010 and provided a 1.1 percent increase for 2009.
In approving the legislation, Congress agreed to delay the Centers for Medicare & Medicaid Services’ durable medical equipment (DME) competitive bidding in order to allow for some quality improvements and reforms to HME policy and the bidding program. The homecare industry will pay for the delay through a nationwide 9.5 percent payment cut on homecare items and services subject to bidding.
The law requiring bidding is five years old, but the implementation rules were not announced until last year. After taking more than six months to review bids, the American Association for Homecare said CMS rushed the implementation, providing incomplete and inconsistent information to beneficiaries.
“I am supportive of competitive bidding as a means of reducing cost, but that cannot be accomplished at the expense of low quality and inconsistent care,” said Senate Finance Committee Chairman Max Baucus (D-Mont.).
Although the DME part of homecare might have gotten a bad rap, the type of care was thrust into the spotlight during 2008 as a better method of quality care and a money saver for the consumer and payers.
Sens. John Kerry (D-Mass.) and Charles Grassley (R-Iowa) introduced the Empowered at Home Act, designed to increase access to home- and community-based services. The law would give states tools and incentives to make services more available to those who need them and affect care provided in homes and long-term care facilities.
“We believe that it’s a large piece of the answer to the Medicare funding crisis, which promises to get worse. Homecare is a small fraction of Medicare spending, but a large part of the answer,” said Michael Reinemer, a spokesman for the AAH.
A rule also proposed by CMS would allow Medicare beneficiaries to receive homecare. Under the new rule, states will be able to set their own eligibility or needs-based criteria for providing HCBS.