The Senate Finance Committee’s Health Care Subcommittee recently held a hearing focused on home health care and aging in the United States.
The hearing covered many topics, including the Centers for Medicare and Medicaid Services’ (CMS) home health care cost reductions, referral denial rates, and the Medicare Payment Advisory Commission’s (MedPAC) views on the industry.
The common sentiment among many home health professionals in attendance was that the hearing was a success.
Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare, agrees. She joined Home Health Care News on the latest episode of her Disrupt podcast to discuss details of the hearing and her optimism regarding future home health payment rules.
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Below are highlights from that conversation, edited for length and clarity.
HHCN: This hearing was held last week by the Senate Finance Committee’s Health Care Subcommittee. This hearing focused on the aging population and the challenges facing America’s home health care providers and patient communities. How did this hearing even begin?
Cunningham: Back at the beginning of this year, we were talking to a number of allies on the Hill who were very interested in home health care. Sen. Ben Cardin (D-Md.) is very interested in holding a hearing on home health care, and his staff has been working with us since February. We came up with a lot of ideas, they had their own ideas, and through that process, the hearing was realized.
Can you explain the format of the hearing and what was discussed over the approximately two hours?
There were a total of five witnesses present at the hearing, and these were the people we proposed, and as I mentioned earlier, Senator Cardin. We spoke with Bill Dombe, president of the National Home Care and Hospice Association. He was there not only as an expert on the Medicare home health program, but really as an expert on home care and in-home care in general. He also invited providers from Nebraska. Her name was Carrie Edwards. She also came as an academic from the University of Washington and has done a lot of research in the area of home care, especially from a rural perspective. Next came Judy Stein, former MedPAC board member of the Medicare Advocacy Center.
How did you feel about that in terms of who was there, including the audience? It seems like it was a great success.
The room was full. I’ve seen many people who understand the health care provider’s perspective and advocate for home health care.
Right from the beginning, the hearing seemed to get off to a good start. The Senate Finance Committee had a large number of both Republicans and Democrats. Sen. Ron Wyden (D-Ore.), chairman of the Senate Finance Committee, attended much of the first half of the hearing. In comes Sen. Debbie Stabenow (D-Mich.), a passionate advocate for home health care and home care.
I was also struck by the level of participation and insightful questions asked by the senators.
Yesterday I spoke with Bill Dombe. As you mentioned, he was a witness at the hearing. He said he left the meeting feeling emotional. How did you feel afterwards?
I agree, it was a really good discussion.
The best thing about this work is that it shines a bright light on how important home care is. Specifically, the Medicare Home Health Program. For older Americans, it’s a lifeline.
No wonder Bill was emotionally high. We all felt it. Many of us have worked in this field of home health care for many years. We believe in this program. There’s nothing better than seeing someone who has undergone surgery, or who needs some services to monitor their condition, recover or rehabilitate, have those services available in their own home. I thought this hearing was a great show of how important that is.
You mentioned the home health care provider voices that were there. That was Carrie Edwards from Mary Lanning Healthcare. I’ll list some of the things she mentioned. Her agency previously covered 13 counties and a 60-mile radius. The cuts were forced due to staffing issues and lower rates earlier this year within a 40-mile radius. And these days, to a 45 mile radius. Her agency is rejecting her 50% of referrals. I thought this was really important because MedPAC sometimes thinks of access as how many government agencies are in each zip code.
I thought it was a great question and starting point for discussion. You can see the data and the very specific metrics being used. You have “access” simply because that agency offers your zip code as part of their delivery area. But we all know that access isn’t real unless you actually get the service when you need it.
I thought this whole discussion highlighted some of the challenges patients have. I think Carey did a good job of highlighting what happens to Medicare patients who are in a hospital bed and need home health services. A discharging physician has ordered a service, but the medical facility does not have the capacity to provide the service. The patient may be hospitalized, sent home without services, and ultimately returned to the hospital via the emergency room. In some cases, you may be directed to a skilled nursing facility.
Were there any other big takeaways from what was said during the hearing, whether it was from witnesses or from senators?
I think another benefit is the senator’s level of knowledge about home health care. They each had their own lens and asked the questions through that lens. I also thought the workforce discussion was a really good one, digging deeper into the larger issues exacerbated by CMS policies. Paying these nurses and clinicians appropriately requires resources.
It seems to me that we are moving in the opposite direction. CMS policy is just the wrong policy at the wrong time. I thought there was a lot of really deep foundational knowledge from all the senators.
As October approaches and the final rule is expected to be announced either then or in early November, how do you feel right now about what that final rule will be? Are you more optimistic than you were before the hearing?
I’m always optimistic. I spoke to many policymakers on the Hill. Support for home medical care is also available.
I understand how important that is. Having a hearing that shows that makes me even more hopeful. We need to make sure our message gets through to the CMS. These reimbursement cuts directly translate into reduced access to health care. We need to make sure her CMS feels the pressure from policymakers in a variety of sectors who say this doesn’t make sense.
Let’s try this again. Let’s reverse these cuts because they are negatively impacting seniors’ ability to access health care at home. Let’s stop here and take a step back. I’m optimistic, but like all of us in the home health community, times are tough. We will continue to do our best until the last moment so that our voices can be heard loud and clear.