In the 21st Century, new technologies are reshaping nearly every aspect of our lives, and healthcare is no exception. Modern technology is bringing significant changes for home healthcare patients, who now have the ability to receive top-notch care at home.
Seeing these changes, the U.S. Congress passed the 21st Century Cures Act in 2016. The law is designed to bring new products and innovations to U.S. patients, and it also included language to encourage the growth of home healthcare.
The 21st Century Cures Act was enacted in 2016, but some provisions affecting home healthcare providers take effect in 2019 or later. The parts specific to home healthcare are in place to encourage home infusion therapy, expand remote patient monitoring (RPM), and reduce Medicare and Medicaid fraud.
New EVV Requirements Aim to Reduce Medicaid Fraud
Beginning in 2019, home health providers reimbursed through Medicaid and Medicare will be required to use electronic visit verification (EVV) technology.
EVV requirements particularly target Medicaid fraud, which surged from $14.4 billion in 2013 to $29 billion in 2015, the year before Congress passed the Cures Act.
Under the new EVV requirements, home healthcare providers will need to record several key data points. This information helps the Centers for Medicare and Medicaid Services (CMS) ensure services submitted for reimbursement actually took place, which improves accountability and transparency in home healthcare.
Providers should be aware that states will set EVV requirements and guide the implementation of the rules, so systems and requirements will vary from state to state.
CMS is also creating a centralized database of home caregivers, as specified by the Cures Act. This database is designed to prevent healthcare providers flagged for fraud from crossing state lines to practice in another area. It will also make it easier for state and federal agencies to confirm caregiver identities and communicate about suspected fraud.
‘Temporary’ Home Infusion Therapy Benefits
In October 2018, CMS announced changes to the Home Health Prospective Payment System. One of these changes was that Medicare will cover certain in-home treatments through a home infusion therapy benefit.
Medicare wasn’t to begin paying those benefits to home healthcare providers until 2021. But under the Bipartisan Budget Act of 2018, home healthcare providers will receive “temporary transitional payments” in 2019 to bridge the gap until permanent benefits kick in. The new CMS rule also sets standards for health and safety standards for home infusion therapy providers.
Remote Patient Monitoring Reimbursement in Home Healthcare
The new CMS rule affecting the home healthcare provisions of the 21st Century Cures Act will also apply to remote patient monitoring. The rule will allow home healthcare providers to report RPM on Medicare cost report forms.
Across the county, a growing population of patients with chronic conditions requires—and in many instances, demands—constant, quality care. In response, healthcare organizations have begun to look to wearables and other new wireless technology to remotely collect patients’ vital health data, helping patients and saving money.
The new rule encourages investments in technology and innovation. These are expected to improve patient outcomes through effective care planning and data sharing.
Penalties, Value-Based Purchasing Programs for Hospital Readmissions
Ultimately, the new rules promoting innovations in home infusion therapy and RPM will reduce the need for inpatient care, cutting the number of costly hospital readmissions and associated risks, such as hospital-acquired infections.
Reducing readmissions has been a goal of CMS since the Affordable Care Act first imposed readmission penalties on hospitals. The Cures Act has helped CMS make the penalties more equitable, but CMS is continuing to focus on reducing rehospitalization rates.
While costly to healthcare organizations, the penalties appear to have a positive effect on readmissions for three conditions in particular: heart attacks, heart failure, and pneumonia. One provider, MaineHealth Care at Home, for instance, reported RPM has helped slash its readmission rate for heart failure patients to 1.2%, compared to a national average of 18%. Other conditions also saw modest declines in readmissions.
Home healthcare providers should focus their efforts on 60-day hospital readmission rates. CMS is likely to expand its current value-based purchasing (VBP) program, where reimbursements are evaluated based on value of care rather than volume of services rendered. CMS has proposed to place greater weight on 60-day rehospitalization rates to evaluate reimbursements under VBP.
Cures Act: Transforming the Landscape
Two years after its passage, the 21st Century Cures Act is poised to transform the way Americans experience healthcare at home. Some aspects of the new rules will present challenges, but home healthcare providers can expect a boost from better reimbursement policies for in-home services and decreased Medicare and Medicaid fraud.
The new law and rules recognize the important roles home healthcare providers will play in the coming decades in helping patients stay out of the hospital and achieve better outcomes.
Skedulo’s healthcare scheduling platform can help home health organizations prepare for coming changes. Take a tour today and see how Skedulo can help your home health organization!