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Carrie Edwards, RN, director of home care services for Mary Lanning Healthcare in Hastings, NE, has a handful of stats to support the negative impact of Medicare home health reimbursement cuts.

Among them: Home care volume has fallen by 60% at Mary Lanning since the beginning of the year. In that time, the firm has declined 55 referrals. While it used to serve parts of 13 counties with 42,000 Medicare beneficiaries, now Mary Lanning can only serve one county with 7,000 Medicare beneficiaries. Staff has begun leaving, fearful the agency will be closing.

Edwards, who has worked for Mary Lanning for 25 years and been director for 13, has never experienced anything like the current crisis, she told McKnight’s Home Care Daily Pulse on Monday.

“It’s really heartbreaking to me,” she said.

Edwards plans to tell her firm’s story to the Senate Finance Committee’s Subcommittee on Health Care on Tuesday when it holds a hearing, Aging in Place: The Vital Role of Home Health in Access to Care. Along with Edwards, witnesses will be William Dombi, president of the National Association for Home Care & Hospice; David C. Grabowski, PhD, professor, Harvard Medical School, Boston, MA; and Judith Stein, JD, executive director/attorney, Center for Medicare Advocacy, Willimantic, CT. (Readers can tune in at 10 a.m. ET to watch the hearing live.)

Edwards and Dombi, for their part, aim to convince the subcommittee about the danger of the administration going forth with the home health proposed rule, which proposes slashing 2.2% from Medicare home health payments in 2024. This includes a 5.653% permanent cut to Medicare’s home health agency rates.

“We will ask the committee to do what it can to prevent 2024 proposed cuts,” Dombi told McKnight’s Home Care Daily Pulse.

He also hopes the hearing will influence the Centers for Medicare & Medicaid Services, which released the proposed rule, on its future decision-making.

“Predictionwise, I think CMS is hearing what we are saying,” Dombi said. “I don’t know yet if they are listening to what we are saying. Part of the strategy is to use this hearing to move them toward that listening mode.”

Declining reimbursements, which primarily have affected staffing levels, are contributing to home care agencies shuttering their doors around the country. Dombi said it is hard to know exactly how many agencies are closing their doors.

While the decline of the home health benefit has been taking place over the last 23 years — since the shift to the prospective payment system in 2000 — the move to the Patient-Driven Groupings Model in 2020 contributed to it, according to Dombi. Edwards has seen that impact firsthand.

“In 2020, CMS changed the payment model … which is what significantly started this trend of decreased reimbursement on how home health is reimbursed per beneficiary,” she said. “So it kind of ties our hands and what we can offer patients without losing money. Because the more we do for the patients, we lose.”

Edwards would like to get back to the days — not so long ago — when the agency was expanding, she said. At one point the agency was covering an area with 42,000 Medicare beneficiaries. In 2020, the daily census was 88. Now it is 32. The agency may have to close, particularly if the proposed home health cuts become a reality, she conceded.

The hardest aspect of the Medicare cuts is “not being able to serve patients in those areas anymore,” she said. “They want our services, they have the right to choose and they always want us and now we can’t serve them.”