“Reverse.” That was the one-word response a house well being care supplier despatched to the Facilities for Medicare & Medicaid Providers (CMS) throughout the remark interval on the proposed 2025 house well being care fee rule.

This remark was an anomaly when it comes to brevity. Though most respondents expressed related sentiments, they selected to make use of extra phrases to take action.

General, suppliers detailed the precise challenges they face of their markets and why the proposed fee rule would affect entry to care.

Under are feedback that House Well being Care Information famous that suppliers observed as they see their margins shrink yr after yr.

Some feedback have been edited for size and readability.

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Inside our market, the variety of house care admissions that embody wound care is growing, and specifically the sorts of wounds coated by this proposal. Any discount in reimbursement for HHAs treating these kind of wounds could be detrimental to affected person care. The price of provides continues to rise, similar to the whole lot else within the financial system, and the labor prices to entry expert nurses or therapists who even have correct wound care additionally improve in these kind of instances.

At our company, we just lately needed to refer a affected person who was despatched to us because of the affected person's insurance coverage to a different company. The affected person developed a strain wound and the nurse despatched to deal with the affected person was not correctly skilled in wound care. Over the following few weeks, the affected person reported that the wound grew to become more and more extreme and was involved that the nurse didn’t appear to know what she was doing. He requested her for some further assist. The nurse introduced her supervisor to watch the wound care supplied and ask whether or not it was good or enough. The supervisor informed her that the one proper factor to do at that second was to name an ambulance for the affected person. The affected person had developed gangrene within the wound and was transported to a hospital. Just a few weeks later, the affected person's leg was amputated slightly below the knee. The end result of the amputation resulted in considerably larger prices to Medicare than paying for ample wound care prices. Worse nonetheless, the affected person's high quality of life is now irreversibly affected by the lack of a limb.

I perceive the necessity to attempt to scale back spending and scale back prices inside our federal price range. House well being care is a good program that may considerably enhance affected person outcomes whereas lowering hospital readmissions. I strongly encourage Medicare to think about growing spending for house well being care corporations to allow them to present high-quality services and rent or prepare their workers with the required certifications and abilities required for superior care within the house. Whereas house well being care prices might improve, I don't assume it's a shock that hospitalizations will lower, which is able to considerably scale back the general value of healthcare whereas enhancing affected person outcomes.

— Major House Care LLC

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I handle a small impartial house well being company in Calumet Metropolis, IL. Yearly we struggle for survival and yearly CMS proposes to scale back reimbursements and add extra laws. Sadly it's the identical this yr. There must be a means you’ll be able to give you a plan to cease this insanity. It’s tough to pay nurses and have sufficient folks within the workplace to satisfy all authorized necessities. Are you able to please take away among the laws so we will get again to caring for sufferers? You may have simply prolonged the RCD for five years. You may have prolonged HHVBP. You added NOAs, however didn’t take away any regulatory burden or improve reimbursement. The hospital programs are dropping house well being companies like flies in Illinois as a result of it seems we’re not useful. Impartial house care companies are closing their doorways as a result of they can’t present care, pay subject workers and sustain with the regulatory burden you impose on us. We’d like a break, please!

– Deirdre Hezekiah Onwukwe

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I want to categorical my considerations in regards to the just lately launched proposed rule for the CY2025 House Well being Potential Fee System (HH-PPS). As an occupational therapist and former house well being care supplier, the proposed adjustments may have a major affect on entry to high quality occupational remedy providers for Medicare beneficiaries. Lowering fee for key occupational remedy providers raises considerations in regards to the sustainability of those important providers, which play a essential function in enhancing the well-being and independence of sufferers of their house environments. There’s a want to take care of a concentrate on guaranteeing that Medicare beneficiaries obtain the very best high quality of care, and ample occupational remedy compensation. I urge CMS to rethink these proposed fee reductions to make sure sufferers proceed to obtain the required occupational remedy providers for his or her restoration and general well being.

– Vera Gallagher

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Whereas we respect CMS's efforts to fight fraud, waste, and abuse, CMS should present clear steering to any supplier coated by a PPEO, together with the timeline for evaluations, the method for any appeals, and the standards for when penalties and fines are imposed.

CMS's proposed charge discount doesn’t take into consideration the excessive prices of inflation, workers shortages, turnover and job stress that house care suppliers face. Combining these challenges with vital cuts in funding would cut back our sufferers' entry to life-changing care. This impacts the sufferers who want us most, who might not have the assets and who’re probably the most susceptible.

Probably the most susceptible populations rely on our high-quality care and these cuts will restrict their entry to care, particularly in rural and underserved areas.

Adjustments within the wage index will transfer some companies from an city designation to a rural designation, additional lowering their compensation at a time when rural companies face better challenges recruiting and retaining staff.

We offer wonderful care to all who want us and even present charity/want care after we can, however additional cuts to our funding would make it nearly unlawful. Our medical doctors work very exhausting and don’t obtain an annual elevate; some haven’t even had a elevate in nearly three years. House care isn’t a simple job, it’s an act of the guts and but they provide the whole lot they need to the sufferers and the group we serve!

— Seaport Scripps House Well being

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My house well being company serves rural Wyoming. With the excessive prices of provides, labor, recruitment, and the general value of serving a rural space, the proposed Rule will nearly remove our skill to proceed serving these areas. We at present face excessive inflationary wages and intense workforce competitors with the hospital and different healthcare suppliers. A 4% discount in our reimbursement will solely make the issue worse.

The 5% wage index cap additionally prevents our rural communities from receiving aggressive wages that permit us to rent competitively.

The necessity for house care in rural communities is simply changing into extra essential. This rule will forestall all house care companies from receiving sustainable reimbursement for offering providers to rural communities.

CMS should take into consideration the general pressures that house care companies are experiencing within the present financial local weather. CMS ought to think about a 5% reimbursement improve.

– Symbii House Well being and Hospice Wyoming

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In comparison with the yr 2024, CMS estimates a 1.7% lower in Medicare funds to HHAs for the yr 2025. Henry Ford Well being is anxious that the annual house well being fee charge replace has not saved tempo with the numerous will increase within the prices of labor, medical care and well being care. provides and different assets essential to supply high-quality care to our sufferers.

A big a part of this discount could be attributed to a lower of 4.067 share factors ensuing from the adjustment of the behavioral assumptions. The changes to CMS' behavioral assumptions are in direct response to regulatory adjustments that house care suppliers should observe because the implementation of the PDGM on January 1, 2020. These behavioral assumptions are difficult as a result of they penalize house care suppliers for selections ensuing from regulatory adjustments. . For instance, one motive for lowering funds below the behavioral assumption adjustment was the declare that there could be a better variety of “house care episodes” for which a comorbidity adjustment would happen on account of contemplating all 24 comorbidities on a declare relatively than solely 5. . Particularly, the PDGM's intent was to rely extra closely on scientific traits and different affected person info to put house care episodes into significant fee teams, with 432 potential case-mix adjusted fee teams.

Because of the results of those adjustments – in addition to the PDGM calculations, the Low Utilization Fee Adjustment (LUPA) threshold, and outlier reimbursement – ​​HHAs will see even deeper cuts than the 1.7%. Henry Ford House Well being Care estimates the discount is nearer to 2.3%.

– Henry Ford Well being

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You proceed to chop caregiver reimbursements and prohibit entry to providers that affect independence, member well being, caregiver sustainability, and members' skill to remain of their properties. You narrow these providers after which blame the suppliers for the poor outcomes. By limiting entry to those providers, Medicare finally spends more cash offering providers to members in hospitals and expert nursing services. Before everything, it’s time to assist members at house and keep their well being. It’s less expensive for Medicare to deal with people who find themselves wholesome sufficient to get better than to supply providers as soon as the ailments have developed and the prognosis is far much less optimistic.

– Anonymously