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Home Healthcare Agencies Questioned over Reimbursements

Janice Simmons, for HealthLeaders Media, May 14, 2010

Four of the nation's largest home healthcare agencies were asked in letters sent by the Senate Finance Committee on Thursday to explain the relationship patterns between the number of home health therapy visits they provided and the Medicare reimbursement rates for those visits.

In the letters sent by Committee Chairman Max Baucus (D-MT) and ranking minority member Charles Grassley (R-IA), the companies were questioned about recent reports that allege they changed their business practices to achieve higher reimbursements when the Medicare reimbursement rate for home healthcare changed. In particular, the senators questioned the companies' use of a patient questionnaire that appeared to assist them in targeting Medicare patients for whom they could be reimbursed.

The senators asked Amedisys, Almost Family, Gentiva Health Services, and the LHC Group to provide answers related to their internal policies and guidelines regarding the number of visits provided to each patient after a Wall Street Journal story reported a connection between the number of visits and the rate of Medicare reimbursements.

According to the Journal article, the number of Amedisys patients who received 10 visits was three times the number of patients who received nine visits—after Medicare rates increased for patients receiving more than nine visits. When the basis for Medicare payments then shifted to six, 14 or 20 visits, those Amedisys patients getting 10 visits dropped by 50%, while patients getting 14 visits rose 33% and patients getting 20 visits increased 41%.

The findings in the Journal article "are of great concern to us" because they appear to be confirmed by earlier research by the Medicare Payment Advisory Commission (MedPAC). That research found that changes in utilization of home health services "demonstrates that home health providers can quickly adjust services to payment changes in the therapy visit thresholds."

These findings overall suggest that home health agencies "are basing the number of therapy visits they provide on how much Medicare will pay them instead of what is in the best interests of patients," Baucus and Grassley wrote.

The senators also asked the companies to provide marketing materials and guidelines for patients and physicians—along with the clinical criteria that were used to develop those materials.


Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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