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Opinion >  Guest Opinion

Christine Opiela: Protect home health in Washington for Medicare seniors

By Christine Opiela Home Care Association of Washington

It’s official: Washington has one of the most rapidly growing senior populations in the country.

Between 2006 and 2016, the number of people aged 65 and older in our state jumped by a whopping 47.2%. Today, we have 1 million retirees throughout the state, and the elderly population is forecast to skyrocket even more in the coming decades. According to a report by the Washington state Department of Social and Health Services, the elderly population is projected to reach almost 2 million, representing 22 percent of the state’s total population, by 2040.

As people in the Evergreen State live longer – and seek treatment for chronic, complex illness – we face substantial challenges in providing the high-quality home health care that patients and families overwhelmingly want. Unfortunately, a new Medicare regulation imposed by bureaucrats in Washington, D.C., will make it harder for health care providers to offer home health services to seniors who want it.

Home health is vital for Medicare patients across the country, including nearly 50,000 in Washington state alone. By taking advantage of skilled health care services in the comfort of their own homes, elderly patients enjoy greater independence and security, aging at home where they prefer to remain. Not only does home health help patients stay close to loved ones, it helps them stay out of hospitals and institutional care settings.

All of this is particularly important in rural areas like Eastern Washington, where there is a shortage of physicians and where patients with serious illness, disability or mobility issues face additional barriers to accessing care in institutional settings.

Patients – particularly rural seniors – unfortunately might find it harder to access home health care due to a new Medicare payment policy that transforms how home health agencies are reimbursed. Under the new payment structure, called the Patient-Driven Groupings Model (PDGM), Medicare reimbursement for home health will be based on unfounded assumptions about what providers might do in the future when providing care – instead of making smart policy decisions based on observed evidence and data. These “behavioral adjustments” to providers’ reimbursement rates threaten to slash more than $1 billion in home health Medicare funding in 2020 alone. Cutting future payments based on shaky assumptions about the future is troubling and has been determined unacceptable for other sectors. It should also be rejected here.

If implemented as written, the PDGM could lead to significant interruptions and gaps in care for patients in Washington and beyond. Though this is not the intention of the new payment model, it could become an unfortunate reality because the reimbursement reduction would create significant financial stress for home health agencies. In turn, this increases pressure and instability in the sector, threatening to force home health providers to reduce or suspend care services in order to stay in business. This would be a devastating outcome, most of all for Washington’s growing population of senior citizens.

To make sure patients can continue to access high-quality home health, reform is necessary. Earlier this year, a bipartisan group of lawmakers introduced the Home Health Payment Innovation Act of 2019 (H.R. 2573/S. 433), which will fix the serious shortcomings of the new payment system. Specifically, it would require Medicare to make reimbursement adjustments based only on facts, not arbitrary assumptions. By empowering the agency to adjust reimbursement rates through observable data about billing behavior, Medicare would effectively ensure that agencies are being appropriately paid for the services they provide.

I commend Congresswoman Suzan DelBene (1st District) for co-sponsoring this bipartisan bill and urge each of her colleagues in Washington’s congressional delegation to do the same. As our senior population continues to grow, providing patient-preferred home health care will only become more important. Passing the Home Health Payment Innovation Act would go a long way toward keeping up with patient demand and preserving access to quality home health care.

Christine Opiela is the executive director of the Home Care Association of Washington.

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