Op-ed: Medicare proposal puts Utah patients at risk

Klaus Tiedge, Klaus Tiedge Fotografie

Unfortunately, proposed changes to the way the federal Centers for Medicare & Medicaid Services (CMS) pays home health providers threaten to disrupt access to care for tens of thousands of home health beneficiaries in Utah and millions more across the country.

If you were to ask seniors across Utah where they’d prefer to spend their twilight years, most of them probably wouldn’t respond, “in a hospital bed.” Instead, you would hear how important it is to be in their homes, supported by family and friends. Thanks to the Medicare home health benefit, 3.5 million seniors around the country have the opportunity to remain in the comfort of their own homes while receiving nursing and/or rehabilitation therapy services to help them recover from an illness or injury.

Unfortunately, proposed changes to the way the federal Centers for Medicare & Medicaid Services (CMS) pays home health providers threaten to disrupt access to care for tens of thousands of home health beneficiaries in Utah and millions more across the country. Known as the Home Health Groupings Model (HHGM), this proposed payment reform would be extremely disruptive to Utah home health patients, causing many to lose access to medically necessary and already low-cost health care services, while creating new administrative burdens for home health care providers.

Among its many provisions, HHGM moves toward shortening the typical 60-day home health episode of care to 30 days and places beneficiaries into arbitrary “payment groups” that determine how much Medicare will reimburse providers for care provided to each patient. While the original stated intention of this policy was to control costs and promote efficiency, it will likely do the exact opposite, as providers struggle to keep up with significant rate reductions that result from the rule and new, complicated billing and reporting requirements. Preliminary analysis of this new payment structure shows Utah — especially rural Utah — would be hit particularly hard with unevenly distributed payment changes.

Furthermore, the HHGM would decrease utilization of effective services, such as physical, occupational and speech therapy, that help keep…

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