Examining the Potential Impact of Multiple Payment Policies on Rural Versus Urban Home Health Agencies
Home health agencies are navigating several new and upcoming Medicare payment policy changes. These changes include 1) revised targeting and beginning of phase out of rural add-on payments that became effective in 2019; 2) the Patient-Driven Groupings Model (PDGM), a new prospective payment system scheduled to be implemented in 2020; and 3) the Home Health Value-Based Purchasing (HHVBP) demonstration.
All Medicare-certified home health agencies (~12,000) serving fee-for-service beneficiaries will be impacted by the PDGM. The revised rural add-on payments impact all home health agencies that serve rural beneficiaries. About 2,000 home health agencies are currently participating in the HHVBP demonstration, of which 13% are rurally-located.
The cumulative impact of these policies on home health agencies has not been explored. The proposed study will estimate the cumulative impact on home health agencies, comparing home health agencies operating under one, two, or all three policies. We hypothesize there will be differential impacts based on rural-urban status, community factors, and home health agency characteristics. We will estimate and report impacts by rural-urban status, community factors, and home health agency characteristics. We will compare the cumulative impacts with the separate impacts of the three individual payment policy changes. We will then identify rural counties where access to and/or quality of home healthcare may be most impacted by the cumulative payment policy changes.