Electronic Health Reporter

By Lee Horner, CEO, Synzi.

Rural healthcare organizations and their patients are up against a myriad of challenges, from minimal funding and resources to limited access to care, social determinants of health, and more barriers that stand in the way of effective care delivery. Unfortunately, nearly half of rural hospitals operate at a negative margin and are struggling to survive, according to iVantage’s 2017 Rural Relevance Study.

The number of rural hospital closures has risen to 87 in the last eight years, according to the National Rural Health Association (NRHA). The closures create a large gap in healthcare resources available in rural communities, as the residents cannot always drive or fly great distances to access needed care. Virtual care technology can address gaps in care and help rural providers continue to deliver care for the vast populations and geographies they support.

Increased re-admission rates amongst rural patients are driven by inadequate care and support after the patient returns home. Home health organizations now play a critical role in helping hospitals reduce these rates by providing care to rural patients, especially during the initial thirty days after discharge. Home health organizations are actively implementing virtual care platforms to automate the post-discharge follow-up with a rural patient by sending reminders to schedule appointments for post-discharge virtual visits via the communication channel of the patient’s choice – e.g., text, SMS, email or even a phone call. Follow-up care can be provided in a cost-effective video call (for home health providers and patients) which optimizes the caregiver’s productivity by minimizing excessive transportation time, travel costs and related liabilities typically associated with driving to/from patient homes.

To help home health agencies, there has been a longstanding Medicare rural add-on for home health services. Federal add-on payments through the Center for Medicare and Medicaid Services (CMS) have been crucial to these agencies operating in rural regions of the country. The 3 percent payment modifier to reimbursements for services provided in rural and underserved areas helps these agencies which face higher overhead expenses through factors such as increased travel time between patient visits and demands for extra staff. This payment modifier is imperative so that rural agencies will be able to keep their doors open and provide necessary care to home-bound patients.

However, the Centers for Medicare & Medicaid Services (CMS) has proposed payment rules which may impact the delivery of home health care in rural communities. The shift was mandated by the Bipartisan Budget Act of 2018. Under the new methodology, CMS is varying add-on amounts depending on a rural county’s home health utilization, population density and other factors. Unlike the current standard of a 3 percent three percent rural add-on, CMS’s proposed payment rule segments counties into “high utilization,” “low population density” and “all other” categories:

High-utilization counties are “rural counties and equivalent areas in the highest quartile of all counties and equivalent areas based on the number of Medicare home health episodes furnished per 100 individuals who are entitled to, or enrolled for, benefits under part A of Medicare or enrolled for benefits under part B of Medicare only, but not enrolled in a Medicare Advantage plan under part C of Medicare.” Low population-density counties are designated due to their population density of six individuals or fewer per square mile of land. The all-other category includes counties and areas that don’t fit into either definition.

With the new ruling, high-utilization counties would receive a 1.5 percent rural add-on in 2019, followed by a 0.5 percent add-on before the payment bump is phased out entirely. Nevertheless, low population-density counties would receive a 4 percent rural add-on in 2019, a 3 percent bump in 2020, a 2 percent increase in 2021 and a 1 percent add-on in 2022. Payments would potentially stop in 2023. All other counties would receive a 3 percent rural add-on payment in 2019, a 2 percent bump in 2020 and a 1 percent increase in 2021 before payments go away.

Keith Myers, chairman of the Partnership for Quality Home Healthcare, shared his perspectives with The Hill and noted that “Medicare’s home health care benefit is essential to keeping aging Americans healthy at home – particularly for seniors living in rural America where health care options are limited. By enabling rural seniors to age with dignity and comfort in their own homes, Medicare is also reducing health care spending by preventing avoidable hospitalizations that drive up costs and put seniors at greater risk.”

Moving forward, the overall healthcare ecosystem is better served when quality care is brought to the patient in the setting which is most comfortable, convenient, and cost-effective for all stakeholders. Technology such as a virtual care communication platform can help home health agencies bring care to these rural patients’ homes without incurring additional costs, regardless of the rural add-on nuances.