Skip to comments.Reform Medicare, Donít Cut Necessary Benefits
Posted on 10/29/2017 7:58:06 AM PDT by Kaslin
Conservatives have always advocated the idea of keeping the safety net intact, while reforming the big three entitlement programs: Medicare; Medicaid; and, Social Security. Reform is different from cutting programs. The left constantly accuses the right of advocating deep cuts to entitlement programs that benefit low income Americans. The correct position for conservatives is to advocate strong reform to attack waste, fraud and abuse without cutting essential services that people rely upon especially the elderly.
One plan that falls into the category of a cut and not a reform is a current plan to cut home health benefits provided under Medicare. Payments for Medicares home health benefit are poised to undergo the most substantial change in the last 17 years if implemented as proposed. If not withdrawn, these policy changes could spell big trouble for the 3.5 million American seniors who depend on home healthcare.
In its latest annual home health payment rate update proposal, the Centers for Medicare & Medicaid Services (CMS) proposed a complex new payment system known as the Home Health Groupings Model (HHGM), which would fundamentally alter how Medicare beneficiaries receive home health services. Developed without direction from Congress, and with no input from stakeholders, this proposed model would significantly upend the home healthcare sector jeopardizing patient care while imposing dramatic cuts to reimbursement rates.This is being proposed as a reform, yet it seems to sound more like a plan just to save some federal cash on the backs of the elderly.
Though it was originally intended to promote efficiency and save Medicare money, the plan will do the opposite. Slated to roll out in early 2019, the rule would place beneficiaries into new payment groups that determine reimbursement based on patient characteristics rather than care needs, meaning some beneficiaries with complex care needs may have difficulty accessing services. The standard episode of care would be cut in half, from 60 to 30 days, and the new case-mix would discriminate against patients with long-term care needs. Obviously, longer term care is more expensive, yet it is exactly the type of safety net that many need.
The reduction in total home health payments is even more of a drastic change well beyond current levels leading to an estimated $950 million reduction in 2019 alone. Medicare home health benefit has been a favorite Medicare target of cuts over the last decade. Reforming a program to save $950 million in a year is a great idea, unless if that reform comes in the form of ill-advised cuts to essential services that leads to harm to those in need of help. A better idea would be to police these programs to weed out actual waste, fraud and abuse, so as not to cut essential benefits to older Americans.
Cuts to home health are nothing new and a favorite target of government bean counters. Its worth remembering that the last time CMS pushed through non-budget neutral payment reforms when it implemented the Interim Payment System between 1998 and 2000 more than 1.5 million Medicare beneficiaries lost access to care after cuts forced 4,000 home health agencies to close their doors almost overnight. This time around, hundreds of millions of dollars of additional cuts would likely cause further loss of home health services, forcing beneficiaries to seek care in more expensive settings.
Serious questions remain about the legal and policy authority by which CMS has undertaken this massive payment change especially considering that the changes are not expected to be budget-neutral. And despite ongoing requests for data, CMS has not provided the critical information required to fully assess the impact of the proposal and to replicate CMS own analysis. Without these key details, stakeholders are unable to suggest improvements to the proposal or even understand how it was developed. Providers will have difficulty adapting to such a rapid change.
CMSs efforts to transform Medicare from a volume-based model to one based on the value of care delivered is a good idea. Such a value-based system would spur the industry to pursue new and innovative strategies that would benefit patients and providers alike. However, HHGM does nothing of the sort. Instead, the proposal would redistribute payments away from key home health services like physical, occupational, and speech therapy that are generating Medicare savings in value-based payment models.
The good news is that opposition to HHGM is already building on Capitol Hill. A bipartisan group of 49 Senators signed on to a letter in late September asking CMS to hold off on implementing HHGM and a similar effort is underway in the House. Senator Orrin Hatch, who chairs the Senate Finance Committee, urged the Administration to refrain from proceeding with the model until a less disruptive solution can be found.
Absent action from CMS, Congress should take action on its own to protect seniors home healthcare by urging CMS to withdraw the proposed Home Health Groupings Model and instead work with stakeholders to develop a true value-based payment system that preserves access to this critical benefit while promoting efficiency and cost-savings.
“Cuts to home health are nothing new and a favorite target of government bean counters. Its worth remembering that the last time CMS pushed through non-budget neutral payment reforms when it implemented the Interim Payment System between 1998 and 2000 more than 1.5 million Medicare beneficiaries lost access to care after cuts forced 4,000 home health agencies to close their doors almost overnight.”
Dad & I will be on the Front Lines of this, should it come to fruition. His greatest wish is to remain in his apartment until the very last second. I and another woman do EVERYTHING for him. He is legally blind, and has a whole host of other healthcare problems. We are meeting with a surgeon in the next few weeks to have his cataracts removed, though there are only 2 surgeons in our area that do that operation.
Anyway, I’ll be sure to tell you my tales of woe if and when this happens. I had to deal with the 0bamacare nightmare and find ways around it for my company and employees, so it’s not like I don’t have any practice with Government messing with me.
So TIRED of all the BS coming out of Government these days. JUST when you think you might get a bit ahead, they come up with some other scheme to mess with us!
For forty-PLUS years I was FORCED to pay for these programs. I had absolutely NO CHOICE! Now a bunch of crooked politicians on both sides of the aisle say they may not pay MY MONEY back to me because of THEIR mismanagement and because they have doled money out to illegal aliens, many of whom never paid in a dime!
These swamp dwellers better damn well be prepared to be treated like common street muggers!
I’d prefer to reform all 3 and cut medicaid/medicare. The last 2 are one of the main reasons why healthcare costs continue to rise 8% annually since 1960.
There’s no reason to frighten Americans by proposing cuts to basic services or to float the idea of taking away benefits already in place, for any of these tax proposals. To do so is foolish and counterproductive. The public isn’t stupid. They know that once any received benefit is taken away, they’ll never get it back, the benefits saved will be given to someone else to buy votes, they themselves will be worse off, and the Powers That Be will eventually negate the savings of any tax cut by raising it again when they think people have forgotten the whole tax debate.
>>For forty-PLUS years I was FORCED to pay for these programs. I had absolutely NO CHOICE! Now a bunch of crooked politicians on both sides of the aisle say they may not pay MY MONEY back to me because of THEIR mismanagement and because they have doled money out to illegal aliens, many of whom never paid in a dime!
These swamp dwellers better damn well be prepared to be treated like common street muggers!
Hardly anyone paid in enough to cover their medicare and no-one in medicaid did...most people would get like 25% of their current coverage even with the employer portion. SS is a different story.
Is McCain’s viagra a “necessary” medication?/s
In 2000 at the NAHC convention, there was a person from CMS there who admitted that when they squeeze hospitals, home health and nursing homes explode. And when they squeeze nursing homes, hospitals and home health explode. And when they squeeze home health, hospitals and nursing homes explode.
Home Health is a favorite target because it’s grown so much. But it’s the least expensive alternative of the three. The average 90 day episode on home health costs less than half of a 30 day stay in a nursing home. And a 30 day stay in a nursing home cost what a 2 day stay in a hospital costs.
The problem is made worst by a very strong nursing home lobby that advocates policies that are in Nursing home’s interests, not patient interests.
The article rightly calls for reform not cuts in benefits. Democrats accuse Republicans of trying to cut benefits. And unfortunately they are right. When the GOP had control of congress during the Clinton years, they voted for arbitrary cuts to Medicaid which hurts the poorest of the poor.
Paul Ryan’s first budget called for cuts to entitlements, instead of fixing the economy so that we could afford the entitlements. That’s one of many reasons I voted for Trump. He understood, you needed to get the economy going in order to afford Medicare and Medicaid.
Most of Congress is still clueless.
That may be true, but they were going to put our contributions in a "lockbox" where it would "grow" [please suppress your laughter].
The mental giants in DC came up with this socialist scheme. Of course now they'd like for us to "die early and quickly".
Here we go again....”I’m a conservative, but I love socialism that takes from others and gives to me”. SS and Medicare are both “paygo”, i.e. they took our money and immediately gave it to someone else (there are no real “trust funds”, “lockboxes”, etc). When we say we are “entitled” because our money was taken from us, we make no more moral sense than someone who mugs you and justifies it on the basis that someone mugged him. “Social welfare programs” are just evil vote-buying ponzi schemes, and ultimately someone gets left holding the bag. Looks like it may be us...
Agreed, but the fact of the matter is we spend over half the healthcare costs in this country in the last 6 months of someone’s life. That is 8% of GDP spent to add a month or two at the very of your life. That is a horrible investment. If you have the dough and want to do that on your own or your families dime, more power to you. But it’s killing the country’s finances and many believe will ultimately bankrupt us (mathematically certain it will if it continues to go up 8% annually in costs for much longer).
Another thing that’s not well understood, is that Home Health is intended for people who are getting better. The home health agency has to show patient progress or they must discharge the patient, even if care is still needed.
They can justify keeping them on if there is some kind of set back such as a temporary illness, or a fall, or a hospitalization.
But if the patient isn’t showing progress from one episode to the next, then they must discharge the patient. The patient then gets weak, falls, or something else happens. They end up back in the hospital. And when they come out they get home health again.
But it would have been far more cost effective just to keep them on Home Health instead of removing the care until the patient needs hospitalization.
privatize it all:
Social security. Privatize enough assets of US government to
fund private retirement. Think reit for government lands, oil leases, radio frequencies.
Health care. Privatize it all VA, Medicare, Medicade. Government pays only premium credit. Insurance companies across state lines, binding arbitration in place of tort reform for medical claims.
Welfare. No direct payments. Lifetime limit of 5 years of payments, drug tests.
Yup - my retirement planning assumes no government help at all.
DITTO!!! The most aggravating sentence I hear these days is: THIS TEST/PROCEDURE ISNT COVERED BY MEDICARE.
PS-I actually thought that paying into Medicare for 50 years meant that my healthcare and prescriptions would be covered after I retired. HOW WRONG I WAS!
The real problem is SSDI. Way too many people on SSDI are out waterskiing on the weekends. If you can walk, stand, or sit on your own, NO disability!
I think Medicare should be abolished. Not for current recipients but for the future yes. Phase it out in such manner to give todays working folks plenty of opportunity to arrange, prepare to take care of themselves - but get the federal government the hell out of our health care (and any welfare programs for the genuinely incapable or incompetent should be from the states and NOT the feds - the feds are neither able nor properly empowered to mess with individual citizens and our lives like this).
“...Conservatives have always advocated the idea of keeping the safety net intact, while reforming the big three entitlement programs: Medicare; Medicaid; and, Social Security...”
The above statement is not true. Conservatives warned that Medicare was a “step in the door” to socialized medicine. And today we have an over-medicated population and the quality and availability of “good doctor” care has deteriorated.
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