Analysis: Oregon Home Health Medicare Margins on Steep Decline Home Health Leaders Urge Careful Consideration of Data in Implementation of ACA's Rebasing Provision to Protect Seniors' Access to Cost-Effective, Patient-Preferred Home Healthcare

WASHINGTON, June 12, 2013 /PRNewswire-USNewswire/ -- The Partnership for Quality Home Healthcare today released data demonstrating that the rebasing of Medicare home health payments within the proposed Home Health Prospective Payment System (HHPPS) rule for 2014 would negatively impact Oregon's home health sector and the more than 21,000 vulnerable Medicare beneficiaries receiving home health by driving Medicare margins to an all-time low.  Home health leaders are urging regulators to carefully consider home health sector's current-law economics when implementing this policy.

Under the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) is directed to rebase home health payments between 2014 and 2017 by a percentage determined appropriate by the Secretary.  This percentage is to be implemented in equal increments during each year from 2014 through 2017.

Analyses developed with the support of Dobson DaVanzo and Associates and Avalere Health indicate that the current trajectory of Medicare home health reimbursement is on track to produce negative margins by 2017 in 10 states, including Oregon, even if home health payments are not subjected to further legislative and regulatory reductions.  Under this 'best case' scenario, using the Medicare Payment Advisory Commission (MedPAC) methodology for calculating margins (which has been found to exclude many costs that home health agencies routinely bear), Oregon's Medicare home health margin will fall to -8.8 percent by 2017.  

This decline is due to the impact of an estimated total of $72.5 billion in Medicare home health payment cuts – equivalent to a 22 percent reduction – made since 2009 through legislative and regulatory changes.  

"Home healthcare is a valuable and clinically-effective healthcare service to the seniors of Oregon, who will be put at risk if home healthcare is subjected to more Medicare funding cuts," said Eric Berger, CEO of the Partnership.  "Our community has been impacted by significant cuts in the last four years, which data show will put Oregon home health Medicare margins in the red without any further payment changes."

The analyses illustrate the impact of cuts projected under multiple rebasing scenarios for the state of Oregon including: -0.5 percent rebasing, -1.2 percent rebasing and -3.5 percent rebasing annually from 2014 to 2017: 

  • If payments are rebased at 0.5 percent per year, the national average Medicare margin would fall to 2.7 percent in 2017 and 18 states would have negative Medicare home health margins.  In Oregon, Medicare home health margins would fall to -12.2 percent.
  • If payments are rebased at 1.2 percent per year, the national average Medicare margin would fall to zero percent in 2017 and 19 states would have negative Medicare home health margins.  In Oregon, Medicare home health margins would fall to -13.5 percent.
  • If payments are rebased to the statutory maximum of 3.5 percent per year, the national average Medicare margin would go negative beginning in 2015 and plummet to -11.4 percent in 2017, with every state in the nation projected to experience negative Medicare margins.  In Oregon, Medicare home health margins would fall to -24.9 percent.

According to the May 2013 employment report from the Bureau of Labor Statistics, the home healthcare sector is playing a very positive role in our nation's economic recovery.  Approximately 11,000 new healthcare jobs were added in May, of which nearly 7,000 were new home health jobs.  A rebasing regulation that imposes further funding cuts, however, could jeopardize these gains and cause many providers to incur net operating losses, leading to potentially significant job losses.

"We urge decision-makers to consider the economics we are already operating in before further reducing needed Medicare funding. Instead of more cuts, we urge lawmakers to embrace pro-patient solutions that better ensure beneficiary access to clinically advanced, cost-effective, patient preferred home healthcare services for all seniors," added Berger.

Across Oregon, 21,161 Medicare beneficiaries receive skilled home healthcare from 56 home health agencies employing 3,550 home health professionals.  Approximately two-thirds of these agencies service patients in rural areas of the State.   Nearly one-half of these agencies serve patients living in rural areas of the state.

The Partnership for Quality Home Healthcare was established in 2010 to assist government officials in ensuring access to skilled home healthcare services for seniors and disabled Americans. Representing nearly 2,000 community- and hospital-based home healthcare agencies across the United States, the Partnership is dedicated to developing innovative reforms to improve the quality, efficiency and integrity of home healthcare. To learn more, visit To join the home healthcare policy conversation, connect with us on Facebook, Twitter and our blog

SOURCE Partnership for Quality Home Healthcare


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