Home Care Cuts to Reimbursement

Tariq Hafeez, Esq.

Owners and operators of home care agencies are bracing for significant reimbursement cuts by Medicare set to begin in 2014 and run through 2017.  CMS’ June 27 proposal to drop payments by the maximum amount suggested under the Patient Protection and Affordable Care Act will result in an average of 14% reduction in reimbursements over the next four years.

These proposed cuts, according to industry analysts and home care owners, will result in an industry shake up leading to many home health agencies either closing their doors or consolidation. This may present an opportunity for some agencies to acquire other agencies or consolidate creating greater opportunities for growth. On the other hand, smaller agencies may be forced out of the market due to the cuts and inability to compete in a tighter and more competitive market.

While CMS estimates that Medicare would save $22 billion as a result of the drop in reimbursement rates, home care agencies are concerned about the disruption to their industry and the adverse effect of the closure and consolidation of agencies on patients. Moreover, the reduction of home care will likely result in increased costs to Medicare long term from increased hospital readmissions, emergency room visits and lower quality care.

The Patient Protection and Affordable Care Act calls for CMS to “rebase” home health payments through 2017, and shareholders had hoped the final cut would be softer than the proposed 14% maximum rate reduction, which will be phased in evenly over four years.

This reduction would be the latest hit in a rough stretch for home health providers.  CMS has been chiseling away at reimbursement—in part as a way to deter perceived fraud and abuse and also to target previously large profit margins. For the foreseeable future, providers will be forced to adapt to a learner payment environment than previously, and will face challenges to become more efficient in delivering quality care to Medicare beneficiaries.

Tariq Hafeez, Esq. focuses his practice on health care law and regulation.  If you are a home care owner or operator and have questions on how the new cuts may affect your agency, please contact Tariq at 248-380-0000.