Two VNAs have become the first home health agencies to be selected as lead providers in a program for non-homebound Medicare patients who are at risk for repeated hospital admissions and emergency room use.

Both VNAs believe the incentive payments they can earn as participants in CMS’ Independence at Home demonstration will provide them with the necessary resources to serve more chronically ill patients.

The VNAs are part of an initial group of 16 participants in the three-year demonstration which CMS announced April 14. While CMS is no longer accepting applications, it will soon announce a second set of participants which could include more home health agencies.   

Visiting Nurse Health System in Atlanta was selected for the initial demo group mainly based on a house calls program it began in 2010 at its own expense. The program is staffed by a physician and two nurse practitioners, all of them on the agency’s payroll.

 But the program currently averages only $120 per visit in Medicare Part B reimbursement, compared with costs of $150 a visit,says Mark Oshnock, the agency's president. The need to subsidize those visits means Visiting Nurse Health System now can only afford to offer the program in Atlanta, rather than its entire service area, Oshnock notes.

Visiting Nurse Health System and the second VNA, Christiana Care VNA in New Castle, Del., also believe participation in the demo will help them grow traditional home health referrals.

For more on this story, see an upcoming issue of HHL.