Home Health Blogger

Home Health Management: HHS Plans Billing Changes

Posted by Nathan Hope on Feb 2, 2015

The Obama administration has recently announced that it would like to make some changes to the home health management billing systems. The plan seeks to tie 50% of fee-for-service Medicare reimbursements to alternative, quality0based payment methods by the end of 2018.

Last Monday, senior officials with the U.S. Department of Health and Human Services (HHS) provided some background information in a briefing for reporters. The officials stated that Medicare will use payment models such as accountable care organizations (ACOs) with the addition of bundled payments in the new implementations. HHS would like to see these changes realized by setting a goal of making at least 30% of these reimbursements quality-based by the end of 2016.

HHS has set an end goal of having 90% of Medicare-based payments, including the value based purchasing and readmissions programs also tied to the new payment models. $362 billion in Medicare fee-for-service payments were made to physicians in 2014 and approximately 20% of those were made through value-based payment models.

“Today’s announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health care dollars more wisely,” HHS Secretary Sylvia M. Burwell said in an accompanying statement. “We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement.” 

HHS has met with several medical industry executives, insurance companies, and other consumer organizations to explain the plan and how it might be successfully implemented. HHS plans to create a Health Care Learning and Action network in order to aid in cooperation with providers, states, payers, and consumers.

Mark Friedberg, MD, MPP, senior natural scientist with the RAND Corporation, said the long-term impact of the announcement will depend on how the government defines the concept of value-based payments. "If you're counting every dollar an ACO [accountable care organization] or a medical home pilot as being value-based, the goal seems achievable but it may not mean that much, because these are programs that are still running on a fee-for-service chassis. That's where most of the dollars are being generated. But if they're talking about most of these dollars coming in the form of performance bonuses, that would be a real change for Medicare," Friedberg said.

In a statement regarding the initiative, the U.S. Department of Health and Human Services stated, “Today’s announcement by the U.S. Department of Health and Human Services aligns with the American Medical Association’s commitment to work toward innovative care delivery reform that will promote high-quality and efficient care for our nation’s seniors who count on Medicare, while reducing the administrative and regulatory burdens physicians face today.”

“The current focus on fee for service payment must end and be replaced with better alternatives such as blended or prospective global payment models which promote value over volume,” said Douglas E. Henley, M.D., executive vice president and chief executive officer of the American Academy of Family Physicians. “These goals for payment reform are critical to achieving what family medicine is really all about: delivering the right care, at the right time, to the right person, in the right place.”


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