Healthcare worker helps woman in home with physical therapy

The Center for Medicare Advocacy (CMA) accused the Centers for Medicare and Medicaid Services (CMS) on Thursday of using unfair practices against beneficiaries requiring longer-term home healthcare.

In a post on its website, CMA said the new payment system Medicare adopted last year, the Patient-Driven Groupings Model (PDGM), is prejudiced against beneficiaries with long-term illnesses. Results from the first year show a sharp decline in payments to agencies after 30 days of home healthcare (see chart below).

“Results from the first year of Medicare’s home health payment system, PDGM (Patient Driven Groupings Model) reveal that Medicare home health payments for the first 30 days of care are, on average, more than 34% higher than for subsequent 30-day periods of care — regardless of the amount of home health services a patient needs, or for how long,” the organization said.

The group says while Medicare coverage for home healthcare isn’t time limited under law, Medicare beneficiaries are being discharged from services faster than ever before. CMA says it regularly hears from beneficiaries who have been told by home health agencies that they only provide short-term care.

The center says patients with longer-term conditions, including diabetes, stroke, multiple sclerosis, Parkinson’s, ALS, heart disease and pulmonary disorders are often denied ongoing coverage for which they are entitled.

“Repeatedly, the Centers for Medicare & Medicaid Services (CMS) has implemented practices that have a discriminatory impact (through policies, procedures, payment and quality models) to encourage that only short-term, post-acute care services are provided,” the group said, adding, “PDGM, the Medicare home health payment model implemented in 2020, is one such discriminatory policy.”

The chart above shows the decrease in case-mix — which equates to a similar decrease in payment — from the first 30 days to the second 30 days of care for the complete list of  clinical groups in PDGM, according to CMA. Every patient fits into one of these clinical groups.