CMS releases 2008 Medicare home health services payment regulation

Pay-for-reporting, the precursor to pay-for-performance (P4P), continues to roll through Medicare payment rules for various provider types.  Yesterday the home health rule went on display.  It is slated for Federal Register publication by the end of the month. 

The rule includes a 2% holdback for them that don’t report on NQF measures. The CMS press release says:

This final rule adds two new National Quality Forum (NQF) endorsed measures, Emergent Care for Wound Infections, Deteriorating Wound Status and Improvement in Status of Surgical Wound, to the 10 measures that are currently reported for a total of 12 measures to be reported by HHAs in CY 2008.

The press release also announces:

The home health market basket increase for CY 2008 is 3.0 percent, which results in $430 million in additional payments to home health agencies in CY 2008.

Not so fast!

Dig a little deeper, and we learn that there’s a nearly 3% negative payment adjustment for each of the next three years to account for past upcoding transgressions.  This little gift is due to the fact that CMS has now determined that 92% of the case-mix increase from 2000 to 2005 was unrelated to actual increased patient acuity.  (I’ll leave it to someone else to moan about the potential for misplaced punishment here.)  Case-mix calculation for propsective payment determination is also being tweaked accordingly.

— David Harlow