The Centers for Medicare and Medicaid (CMS) just announced a three-month delay of the implementation of new rules for face-to-face encounters for home care and hospice patients and their physicians. The National Association for Home Care and Hospice commends CMS for recognizing the need to delay implementation and is grateful that CMS listened to our concerns and has given a reprieve in the enforcement of the face-to-face encounter requirements. This is a serious issue and it is important to protect the care provided to patients. While this is not a total solution to the issues, it is an important first step.
While we are grateful to CMS for recognizing the need to delay implementation, the National Association of Home Care and Hospice has concerns about the impact of these requirements on the care of our patients and view these new rules as a looming crisis for many of the 4.5 million people in the United States who receive Medicare home health and hospice services and the many more who will receive it in the future. Home health care encompasses nursing services, physical therapy, occupational therapy, speech-language pathology, medical social services and home health aide services designed to help people recover at home from an illness or injury. Hospice patients are people who are dying. They accept that they are dying. In hospice, a team of health care professionals do everything possible to make their last days as pain-free and comfortable as possible. Without home health and hospice services, Medicare will end up spending a lot more money to care for these patients.
This essential care is in jeopardy because of the new federal regulation issued by Medicare in November that states that, beginning January 1st, homebound elderly and disabled patients as well as hospice patients need to have a “face-to-face encounter” with a physician or nurse practitioner if they want to receive care under Medicare. Even with the three-month delay, elderly and disabled Medicare beneficiaries who are confined to their homes for medical reasons or hospice patients in the midst of end-of-life care will need to find a way to either get to the doctor or get the doctor to come see them. There may be valid reasons for this new regulation, but we anticipate disruptions in access to hospice and home health care as most affected people, doctors included, have not even heard of the new rule yet.
Even if Medicare adequately lets everybody know about the new rule, it remains confusing and laden with many ambiguities. The bottom line is that very vulnerable Medicare patients will lose care unless Medicare takes careful and deliberative steps to put this regulation into operation in the real world and not just on the pages of the Federal Register. In the real world, few doctors read the Federal Register. Also, few do home visits. In the real world, physicians are already overworked with endless paperwork and trying to meet regulations that sometimes do more harm than good. As it now stands, the hasty implementation of this new regulation will mean that patients lose access to hospice care and home health services and Medicare spends more money to care for the same patient in the hospital or nursing home. In other words, everybody loses.
The intent of the new rule is to maintain benefit integrity by ensuring strong physician involvement in care planning and authorization. If this regulation is implemented properly, benefit integrity can be preserved without hurting real people who need care. NAHC proposed a transitional period of no less than six months, which would provide a “dry run” and gives everybody a chance to work out any misunderstandings, confusions, or knowledge shortfalls. The three-month delay is a start and we will continue to work with CMS officials on the issue. Ensuring the right to be cared for in our homes is America’s last great civil rights battle. Our goal is to help frail, disabled and dying Americans stay independent and happy in the comfort of their homes.
Val J. Halamandaris is the President of the National Association for Home Care and Hospice.