LEE — Across Massachusetts, more than 110,000 senior citizens and individuals with disabilities receive health care services in their homes from skilled home health care providers. These services help individuals recover from surgery, recuperate following a hospitalization, or manage a chronic health condition that needs frequent monitoring. Thanks to the Medicare Home Health Benefit, these patients receive timely, safe and effective health care when they need it most and in the location they prefer — their own homes.
Home health care is an incredibly convenient delivery model for health care, but; it is also far more. Skilled home health care has become an essential service that doctors depend upon to ensure their patients experience the best possible outcomes. These days, many doctors even require it before they will discharge a patient home from the hospital. It is also a valuable Medicare benefit that has been shown to save millions of dollars annually in reduced hospital readmissions and nursing home stays.
Unfortunately, the ongoing availability of this trusted care here in Western Mass. and across the state could soon face incredible challenges. A new pilot program from The Centers for Medicare and Medicaid (CMS) threatens home health care reimbursement as it requires a "pre-claim review" before a patient's care is approved for coverage by Medicare. Under new guidelines aimed at reducing fraudulent claims, care could be delayed while third-party government contractors, who are not health care providers and have never met the patient, review paperwork and decide whether or not care is actually "medically necessary."
The program's initial implementation in Illinois demonstrated that the pre-claim review demonstration is deeply flawed and should be halted before implemented in the other targeted states, including Massachusetts.
Over the years, Porchlight VNA has been fortunate to provide services to thousands of patients in our community. And our providers unequivocally know that care delays and denials like those seen in Illinois spell disaster for many vulnerable home-bound patients who depend on us.
More poor outcomes
The days following an injury or hospitalization are often the most precarious and are when complications are most likely to occur. Without the readily available, "medically necessary" home care prescribed by a doctor, a patient is far more likely to experience readmission to the hospital. Oftentimes, this is due to unintended side effects from a new medication, an easily treatable infection which progresses to something far more serious, or even a dangerous fall because of decreased mobility.
These are the types of poor health care outcomes that Porchlight VNA is vigilant about preventing, but that are certainly destined to increase if pre-claim review for care delays our ability to intervene. Helping local patients stay out of the hospital in their best state of health has always been, and will continue to be, our number one goal at Porchlight VNA.
Therefore, I strongly urge our local and state lawmakers to stand up for those constituents in need of home health and support legislation to delay CMS' pre-claim review demonstration. The program undermines Seniors' Health (PUSH) Act of 2016, sponsored by Massachusetts Congressman Jim McGovern, and a pause in the Medicare demonstration for one year would allow Congress, Medicare and home health stakeholders to work together to correct the program's flaws. This would ensure patient care is not delayed and that individual beneficiaries are not unjustly denied coverage when they need it most.
I hope that residents of Western Mass., whether they have ever personally benefitted from home health care services or not, will urge our lawmakers to sponsor the PUSH Act. The well-being of our community's home health patients depends on it.
Holly Chaffee is CEO of Porchlight VNA/Home Care and chairman of the Board of Directors, Home Care Alliance of Massachusetts.