A public alarm sounded this winter by a nonprofit home-health care agency in Westchester over changes in the Medicare payment program points to the uncertainty besetting the industry on a range of regulatory issues as federal health care reform legislation is put into practice.
At the Visiting Nurse Association of Hudson Valley in Tarrytown, officials called a proposed co-payment for Medicare patients receiving home care a “sick tax” that will deter patients from services. They said it also will add more costs for the VNA and other home care providers already bracing for “draconian” cuts in payment rates included in last year”™s Patient Protection and Affordable Care Act.
There are some 15 certified home-health agencies in Westchester and more than 11,000 agencies nationwide.
The cuts, which start this year and continue through 2017, amount to $39.5 billion for the home care and hospice industry, said Michele A. Quirolo, president and CEO of VNA of Hudson Valley. The 113-year-old organization operates its three visiting nurse, hospice and home-health aide programs on an approximately $25 million budget.
“For my agency, it means $550,000 in Medicare cuts this year,” said Quirolo, whose recent two-year term as chairperson of the National Association of Home Care and Hospice put her in the midst of the fierce political debate and battles in Washington, D.C. over health care reform.
The seven-year process of Medicare reforms carefully crafted by Congress is threatened, said Quirolo, by recent recommendations by the Medicare Payment Advisory Commission, an independent Congressional agency that would drastically cut home-health payment rates beginning in 2012.
“MedPAC”™s recommendation for additional rate reductions ignores the reality that the majority of home-health agencies today are barely paid the actual cost of the care they provide,” she said.
Quirolo and other home care administrators especially took aim at MedPAC”™s recent vote to recommend that Congress require co-payments for home-health visits to discourage seniors from overusing the service. The commission recommended broadly applied changes rather than targeting those few states where home care services have been overused, Quirolo said.
MedPAC recommended a $150 co-payment for each 60-day period or episode of home care when the Medicare patient does not first go to a hospital or skilled nursing facility. Among the VNA”™s clients in Westchester, those co-payments “absolutely” will deter some elderly from seeking services, Quirolo said.
“It becomes a sick tax, if you will, on the people who can least manage it,” she said.
In a written statement, Val Halamandaris, president of the National Association for Home Care and Hospice, said Congress in 2003 rejected a home care co-pay proposal as “a bad way to encourage people to use the valuable services in home health care.”
Halamandaris claimed co-payments will force chronically ill and disabled persons instead to apply for state Medicaid programs, causing a dramatic rise in Medicaid patient numbers. “The impact of such cost-shifting will precipitate a national crisis as states struggle to carry the weight of caring for the 78 million members of the baby-boom generation” who will need home care, he said.
Quirolo said a Medicare co-pay system also will burden her agency with added administrative costs and lost revenue.
The VNA has a sliding fee scale for patients and, after a fee assessment, would charge a lower co-pay or drop the co-pay for most seniors, she said. “I”™m not going to deny care because someone can”™t pay the co-pay,” she said. “There we go again, we start to take a hit” in reimbursements, Quirolo said. “Every time there”™s a co-pay, it means a no-pay for us.”
Quirolo said 60 percent to 65 percent of her agency”™s reimbursements are Medicare payments. With 680 patients from whom to collect co-payments, “Think about what that”™s going to cost me,” she said.
