Medicare Advantage Lessons from Home Health

Per Hospice News Today, 3/25/23
Medicare Advantage lessons from Home Health that might better prepare hospices...

‘No Contract Is Better Than A Bad One’—Home Health Providers Share Their MA Strategies

Home Health Care News

March 24, 2023

Although home health providers want to see as many patients as possible to keep up with demand, it is impossible under current circumstances. With that in mind, providers are questioning why they would willingly take on managed care beneficiaries knowing they’d be sacrificing dollars. Some industry experts believe providers should, at the very least, be more aggressive in negotiating managed care contracts. To do that, self-evaluation and relationship-building with payers will be key. “Ultimately, the provider community is going to get a lot more aggressive or it’s going to become a big issue, especially as more and more patients are doing Medicare Advantage,” McBee Associates President Mike Dordick told Home Health Care News. “Many providers that offer home health services have not pushed back on managed care providers for years. We are now at a point, with the Medicare margins being cut so deep, that the providers need to get paid a fair rate from managed care for the services they perform.” ... Before beginning these negotiations, it’s important for providers to be realistic and pragmatic about where they are financially and operationally. “Home-based care providers have no choice but to protect their bottom line when it comes to negotiating managed care contracts,” Healing Hands Healthcare CEO Summer Napier told HHCN. “It’s obvious that the sustainability of your organization depends on it. Before beginning any negotiations, you will need to know and truly understand the current state of where your agency stands.” ... At the negotiating table, providers also need to ask critical questions that glean information from payers about how they operate. So much is made about provider transparency, but that’s a two-way street in these situations, Napier said. “You need to know the payer operations before you negotiate a contract with a managed care payer,” she said. “Do they have a large denial rate? Do they have a reduction in authorizations? Do they slow pay? In my experience, no contract is better than a bad contract in most cases. Everyone loses when a bad contract puts a great provider out of business—the patient, the payer and the provider.” ... Avoiding Medicare Advantage completely is off the home health table at this point. With that in mind, providers and payers meeting closer to the middle is likely the best way ahead.