CHART OF THE DAY: A Closer Look At Housing Cost Burdens

Editor's Note: Below is a brief excerpt and chart from today's Early Look written by Hedgeye U.S. Macro analyst Christian Drake. Click here to learn more.


"... As can be seen in the Chart of the Day below, almost half of all renter households make less than $75K so the incidence of moderate and severe cost burdens is the prevailing reality for over 20 million households.


And as housing’s share of wallet grows, capacity for other discretionary consumption declines proportionally.  Indeed, severely cost burdened households spend more on transportation costs and significantly less on Food, Healthcare and retirement savings."


CHART OF THE DAY: A Closer Look At Housing Cost Burdens - 06.29.16 Cost Burden CoD


“Look man. I lay it out for y'all to play it out”

-Huggy Bear, Starsky & Hutch


For the last six weeks or so I've been a reluctant participant in a kind of bizarro Seinfeld'ian reality.


Perhaps the stars have aligned in the elusive Kumbaya formation or the universe is seeking to balance European dissonance with humanistic harmony in my backyard.


Whatever the reason, I’ve been unwittingly ensnared in the great Hug-nado of 2016.


It’s not that I’m against hugging. 


It’s just that as I’ve been introduced to new families in town the last couple months, the hugging – sometimes with the same people multiple times per day – has somehow spiraled in reflexive, self-reinforcing fashion to the upside.  I’ve actually had to increase my advil consumption to guard against rotator cuff inflammation from repetitive high frequency hugging.  


Anyway,  I’m pretty sure central CT is experiencing a localized embracing bubble.  Since I plan on living here for a long time, I hope the inevitable de-hug-eraging  is well managed to a soft landing.


Hugnado  - huyggy bear


Back to the Global Macro Grind


If you feel like you've been a reluctant participant in a bizarro parallel macro dimension where policy maker forecasts are wrong every time, attempted front-running of policy initiatives born of those errant forecasts = “investing”, and where consensus & futures go from pricing in  3-5 rate hikes to a rate cut  in a matter of weeks as price/risk discovery and free market clearing devolve into farcical versions of themselves, fear not …..


Yesterday we received the final estimate of 1Q16 GDP. 


Positive revisions to the Trade balance and Nonresidential Investment drove the upside in net exports and Investment expenditure and the bulk of the positive revision to the headline. 


On the flip side Consumption growth was revised down by -40bps with growth across each of Services/Durables/NonDurables seeing negative revisions of similar magnitude. 


Notably, the GDP deflator was also revised lower by -0.2%, providing a sizeable support to the positive revision.  In total, since the advance estimate of 1Q16 GDP on 4/28, the deflator has been revised lower by -0.3% while headline GDP has been revised higher by +0.6%.


It could be argued whether this is a completely clean way to contextualize it, but it could be fairly contended that suspect inflation inputs have been responsible for a full 50% of the positive revision we’ve seen to growth in the 1st quarter. 


Quickly, for those unfamiliar with the GDP deflator.


101:  First recall that nominal values are values priced in units of currency (a function of volume and price/price changes) while real values are values priced in units of goods & services.  We care about real values because, as consumers, we’re concerned less about total spending than about with how many goods and services we can consume.  Real values are arrived at by subtracting price changes (i.e. “The GDP Deflator”) from nominal spending: 


The GDP price deflator is considered “implicit” in the sense that it’s calculated simply as the ratio of Nominal GDP/Real GDP.  In words,  


  • GDP Price Deflator = Nominal GDP/Real GDP *100 => this give the index value
  • QoQ Deflator = Index Value in Current Qtr/Index Value in Prior Qtr -1  * 4 => This is QoQ price change, annualized and the figure used in deflating reported Nominal GDP. 


Also remember that, by convention, all data are typically reported quarter-over-quarter, seasonally adjusted and annualized (SAAR = seasonally adjusted annual rate). 


If you’re ever unsure how to understand a reported GDP metric, remember the BEA mantra, “If in Doubt, SAAR It Out”.


To be clear, I don’t think the inflation understatement is conspiratorial, I just don’t think it accurately reflects the underlying reality for most households.   


For example, consider the Fed’s preferred inflation measure – Core PCE inflation.   In contrast to the GDP price deflator which was down -0.5% QoQ in 1Q (0.9% in 4Q15 vs. 0.4% in 1Q16), Core PCE inflation was +0.7% higher in 1Q16 (2.0% in 1Q16 vs 1.3% in 4Q15 ). 


If nominal growth were deflated using this “preferred measure” real growth would be measurably negative and real GDP per capita even more negative.


Is this a better reflection of reality where progress towards the Fed’s inflation target is a product not of demand-pull inflation as the economy pushes towards productive capacity but of excess cost growth in key consumer cost centers like housing and healthcare? 


I don’t know, but evidence suggests widespread household margin pressures remain acute. 


On the housing side specifically, the affordability crisis is building.  For the ~43M renter households in particular the percent with moderate and severe cost burdens continues to make all-time highs.   


Per the latest JCHS housing report:

  • 71.5% of Households making <$45K pay more than 30% of income to housing with 42.1% paying more than 50%
  • 59.1% of Households making <$75K pay more than 30% of income to housing with 32.3% paying more than 50%


As can be seen in the Chart of the Day below, almost half of all renter households make less than $75K so the incidence of moderate and severe cost burdens is the prevailing reality for over 20 million households.


And as housing’s share of wallet grows, capacity for other discretionary consumption declines proportionally.  Indeed, severely cost burdened households spend more on transportation costs and significantly less on Food, Healthcare and retirement savings.


Further, with shelter inflation making a new cycle high in May and continuing to grow at a premium to both income and broader inflation growth, the share of cost burdened renters will only get worse when the 2015 & 2016 data are officially reported. 


Now, having fulfilled my bearish humpday research quota, some marginally bullish data to balance and close ….


May PCE:  We’ll get the household income and spending figures for May this morning.  The sum of aggregate hours and earnings growth from the NFP report point to a modest deceleration in aggregate salary and wage income growth (and flattish consumption growth by extension).   


Consensus is looking for consumption to grow +0.4% sequentially.  With retail sales +0.5% MoM in May that’s not an unreasonable estimate.  Further, the lack of a negative revision to the April Retail Sales data reduces the likelihood that the notable rise observed in the April Spending data gets revised lower.


If the April spending data remains unrevised, the +0.6% gain equates to a +2.9% gain in 2Q (remember, you have to annualize the QoQ change) even if total spending growth is flat month-over-month in May and June. In other words, consumption would be a material support to reported growth on the quarter.


While consumption in 2Q is likely to be “good”, that goodness deserves some context. 


A sequential improvement in consumption growth would be in the context of a larger trend towards deceleration.  It’s also worth noting that the deceleration in consumption growth off the 1Q15 rate-of-change peak has occurred despite accelerating credit growth as consumer re-leveraging has proven unable to fully offset the deceleration in employment and income growth.


Further, implicit in extrapolating a ongoing acceleration in consumption growth is an assumption for further acceleration in credit growth, a complete re-inflection in the employment and income cycles (which isn’t how those cycle work), significant wage inflation and a dismissal of decelerating global growth, tighter financial conditions,  and renewed prospects for strong dollar deflation and EU spillover effects.  


To channel Peter Thiel to close: It’s 2016, we were promised flying cars.  We got high frequency hugging, Brexit and peak rent inflation.


Our immediate-term Global Macro Risk Ranges are now:


UST 10yr Yield 1.41-1.61%


VIX 16.84-25.68
EUR/USD 1.09-1.12

Gold 1


To growth,


Christian B. Drake

U.S. Macro Analyst


Hugnado  - 06.29.16 Cost Burden CoD

Eviscerated ... $12,000,000,000,000+ Erased Since Global Equity Top

Takeaway: Global equities have lost $12 trillion in market cap since peaking last June. That's a 19.9% decline!

Eviscerated ... $12,000,000,000,000+ Erased Since Global Equity Top - Stocks crash test dummies cartoon 02.18.2016


Don't believe that the global economy is slowing?


Since peaking last June, global equities have lost $12 trillion in market cap as of this morning. Take a look below at the Bloomberg World Exchange Market Capitalization index.


Yep. That's a 19.9% hair away from full-blown crash mode.


Eviscerated ... $12,000,000,000,000+ Erased Since Global Equity Top - bloomberg world market cap


Here's a look at select equity markets around the globe and their drawdowns since then:


Eviscerated ... $12,000,000,000,000+ Erased Since Global Equity Top - global equities 6 29


What's the big message here?


For starters, global demand hasn't bottomed ... and the outlook remains unequivocally bearish.

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JT TAYLOR: Capital Brief

JT TAYLOR:  Capital Brief - JT   Potomac banner 2

Whatever you are, be a good one.

                   -    Abraham Lincoln


ALL THE RIGHT MOVES: Donald Trump is back on Hillary Clinton’s heels and rallied the faithful delivering an anti-globalization speech in the highly contested rustbelt region. Trump aptly chose a former steel town in western PA for another prepared speech - trashing Republican-backed (and formerly Clinton) at policies promoting free trade (NAFTA, TPP, China), while highlighting the need for an economic renaissance. In the most detailed economic address he has given to date, Trump slammed Clinton for her insider mentality and for rigging the system, and lamented the downturn working-class families have experienced given the decline in American manufacturing. His shift towards a policy speech has all the right moves, but will a change in style win over a divergence in substance?


MIGHT WANT TO CALL THE ORKIN MAN: Poison pills attached to a major funding bill have exterminated any chance for Congress to address the Zika threat; Senate Democrats zapped a $1.1 billion Zika package, claiming the bill did not provide enough research spending and included politically motivated Planned Parenthood language. Congress will now be unable to address the Zika threat for weeks as the upcoming recess is a day away. The House-passed funding package, which was attached to a funding bill for veterans and military construction programs, was under negotiation by House and Senate Republicans after being abandoned by Democrats earlier in the month. The threat of Zika is a clear and present danger (as are House and Senate seats) - chalk up Zika funding as another contentious issue for election season.


YOU’RE HIRED: Trump’s presidential campaign continues to surprise as he takes integral steps - baby ones - in the right direction. Trump’s campaign announced a handful of new hires in its communications operations as he aggressively tries to match the first-rate team backing Clinton. Better late than never - and more hires are expected to be announced soon - including state directors, surrogates, speech writers and convention advisors. With Cleveland fast approaching, the unconventional Trump has been hard-pressed by Republicans to move towards a more conventional campaign - we’ll see if these veteran hires put the Trump train back on track.


SOS PUERTO RICO: Help is just days away - Senate Majority Leader Mitch McConnell quickly pumped the life raft with air as he looks to schedule final passage of the Puerto Rico debt assistance bill ahead of the July 4th recess. McConnell is set to move the House-passed measure, setting up a procedural vote as early as this morning. Though Puerto Rico is on the brim of defaulting on a $2 billion payment due Friday, Senate Democrats are demanding changes to the measure and NJ Senator Robert Menendez is looking to offer two amendments or place a hold on the bill even if it means blowing past the deadline. But, it’s unlikely that Menendez will get that opportunity as amendments face rough waters now that McConnell has filled the amendment raft - leaving no room for Menendez on board.  


BENGHAZI BLAME: Republicans delivered the final Benghazi Committee report that criticized the Obama Administration's handling of the 2012 terrorist attack, while Clinton's campaign continues to classify the findings as discredited conspiracy theories. Either way, there are no new significant revelations about the role played by Clinton. So what’s all the fuss about? The 800-page report is concerning - yet somewhat vanilla - but it's sure to add fuel to the Republican fire throughout the election as they blame Clinton for security lapses leading to the tragic event.


GLOBAL MARKET CARNAGE: A grand total of $2.08 trillion was wiped out of global equity markets on Friday following the UK’s market-shocking vote to leave the EU. It was the biggest single day loss ever. In dollar terms, the huge decline surpassed the day Lehman Brothers went belly-up and 1987’s “Black Monday” crash. While the S&P 500 plunged -3.6% on that historic day, our favorite Macro positions, Utilities (XLU), Long Bonds (TLT), and Gold (GLD), were up +0.6%, +2.7% and +4.9% respectively, extending an already impressive year of double-digit gains in a difficult, down tape. We remain uber cautious on global markets and economy.


HOME HEALTH PAYMENT UPDATE TAKES 1% REDUCTION - MORE CHANGES ON THE WAY: Our Healthcare Policy Advisor Emily Evans shared her insight on CMS’ reimbursement news and it’s expanded discussion of an alternate payment model. You can read her piece here.

NKE | Full Contact Chess

Takeaway: Nike just gave up a pawn, and perhaps a rook, while en route to victory in a critical game of full-contact athletic Chess.

  1. This print was not a surprise. We noted that more could go wrong than right with this release, and that’s exactly what we saw. Even though the earnings algorithm was very respectable, and far better than any direct or even fringe peers, the fact is that every metric that matters turned negative on the margin.
    1. Sales missed. Nike confirmed price pressure with basketball that retailers raised last month.
    2. Futures slowed sequentially, and missed expectations in every region.
    3. Gross Margins were uncharacteristically weak.
    4. Inventories were quite weak – eroding sequentially by 500bps relative to sales.
    5. SG&A remains elevated (Olympics).
    6. Guidance suggests an acceleration throughout the year – but isn’t that a stretch w/Brexit and 23% of Nike’s sales in Europe?
  2. “So…Hedgeye Retail geniuses, how in the world can you be bullish on this stock.” From a TREND perspective, we’re not. But if there is one single factor that people will miss in the quarter, it’s that the near-term stress to the model – particularly given that it involves friction with Nike’s US wholesale accounts (FL, FINL, HIBB, etc…) a channel Nike has increasingly stuffed over the course of this economic cycle – will lead to draconian change to Nike’s business model.
  3. Our TAIL call is that Nike will add $10bn in incremental DTC at a 20 point margin premium to what it has today. Let’s be real about this…making a transition like this – especially in the US – will not be without its stretch marks. Nike won’t do this – and by ‘this’ I mean taking FL, FINL down from 70% of its inventory purchases from Nike to something about 20 points lower – when its business is humming. It will do so when it has to start playing some defense, like it is today. We’ll see similar moves by Nike at most other retailers except Dick’s – which is the sole winner here aside from Nike.
  4. The punchline on Nike is that going from $2.00 in EPS to near $5.00, which is what we think will happen as it consolidates and builds a massive DTC business, is not a linear move over four years. There’ll be quarters along the way where the profit and growth algo looks pitiful. But that’s how Nike rolls, and it’s worked like a charm so far. Keep in mind that its capital investment to build this new business (and other business it’s not even talking about yet) are largely complete. That means when it kicks in it will be lightning fast, and ROIC-accretive almost immediately.
  5. The Stocks
    1. NKE: We’d watch Nike drift lower from TREND perspective as the tape gets muddied by channel shifts. For people looking beyond two quarters, we’d be buying on the weak days, because the TAIL call here is extraordinarily powerful.
    2. FL: We’re short it. There’s no way FL comes out of this smelling better than it does today. Sales should weaken, gross margins should decline (remember 20%+ Europe exposure), SG&A and capex will BOTH head higher at FL tries to build up a more successful e-comm business. Management is good at FL, and it will spend where it needs to – and after its Nike business went from 50% to 73% of revs over six years it really did not have to invest at all (hence unsustainably low SG&A). Now that changes.
    3. FINL: Ditto as what we said with FL – except the part about good management.
    4. HIBB: It’s probably too strong to say that this is ‘terminal’, but it’s close. Growing into more expensive and more competitive markets, no online presence, and maxed out with Nike – all while sporting the highest margins in the industry. We’re modeling that margins get cut in half. No joke. Short.
    5. DKS: The one winner as it takes advantage of a generational land-grab with three competitors going Ch11. In addition, Nike will look to DKS as its new poster child for the retailer getting the most incremental Nike product. DKS already set expectations low for this year. Downside is minimal, and upside is tangible. We like this one. 

NKE | Full Contact Chess - 6 28 2016 NKE financials


Basketball Energy ‘Really High’, Sales Not So Much

There was a considerable amount of real estate allocated on the call (particularly Q&A) to basketball, so forgive us in advance for beating a dead horse. We heard a lot from Nike management about Lebron James the athlete, and his win for the hometown Cleveland Cavaliers, but little about the Lebron product. Same goes for KD. As Nike echoed FL commentary on the premium product price resistance by what it didn’t say. And some of what it did say clearly validated the problem if you read between the lines. For example, look no further than the comment about the KD9 which sold out in its first limited release. The only problem is that the shoe retails at a 17% price discount to the KD8 at $150…close to the Kyrie and Chef Curry kicks price point. Definitely not where wholesalers expect Nike to be.


When it all shakes out, Nike’s basketball business was up 11% for the year. Nike Brand basketball was actually down 1% for the year, while Brand Jordan meaningfully drove the category in aggregate. For some odd reason, Nike started to disclose basketball excluding the Jordan brand – though one would think that the company would try to mask weakness in Nike basketball by lumping both together. We’ll give ‘em a golf clap for that one for transparency.  Though the 11% combined number is good at face value, keep in mind that it had been growing 20%+. Yes, Nike has the full portfolio to offset some of decelerating basketball growth, but the gap in ASP between a basketball shoe and a casual running silhouette has to hurt a little. The brunt of that, we think trickles down to its retail partners.


NKE | Full Contact Chess - 6 28 2016 NKE basketball


What It Means For Foot Locker, and other wholesale partners…

From 2009 through the 1st half of 2015, FL rode the Nike basketball wave as category growth went from LDD to high-teens, FL comps felt the lift from a recession hit (and pre-Hicks agenda) -6% to HSD. Now as the Basketball tailwind rolls off, and FL turns more bearish on NKE than it has been in 14 years, we saw comps decelerate at FL from 7.8% to 2.9% in 1Q16. With NKE readjusting the price/value equation as evidenced by the KD9, that ASP tailwind that FL has relied upon for so long goes away, but the mall traffic problem still persists. Yet, the street is assuming that FL can re-accelerate growth in the back half of FY16 as comp compares continue to remain elevated. With Nike’s, results today, especially in this category we give more credence to the negative 2QTD comp commentary by FL, and are more bearish on its ability to shift the tides through the balance of the quarter.


NKE | Full Contact Chess - 6 28 2016 NKE FL


This Isn’t Good For Foot Locker (or others) Either

This is as glaring a statement as Nike has ever made to its traditional wholesale partners. Yea, it buttered up the likes of Dick’s Sporting Goods and Foot Locker with statements on the call, but those are just words. The numbers here speak for themselves…mainly the acceleration of DTC as a % of total Nike Brand growth from ~20% in 2012 to 70% in FY16. In YY growth rates that’s the difference between 15% wholesale growth in 2012 and 2.8% growth in 2016. That point was hammered home in the most recent quarter when DTC grew 20%, and wholesale was flat. Maybe, the TSA bankruptcy and other disruptions offer a 1-2% buffer to the wholesale number this quarter, but the trend is overwhelmingly anti-wholesale.

Yes, there is plenty of talk about the outsized growth from AdiBok and UA footwear – but to keep things in perspective, for every 1% share in Nike NA footwear the company pulls away from the wholesale channel, AdiBok and UA would need to grow their corresponding businesses at 6% and 14% respectively.


NKE | Full Contact Chess - 6 28 2016 NKE DTC


Gross Margin Masking the DTC Benefit

By our math, the gross benefit in the quarter from outsized DTC growth (+20.4% vs. wholesale flat) should have been in the range of 50bps. That assumes an e-comm GM of about 70% and store GM of 50%. Unfortunately NKE doesn’t operate in a bubble and the combination of Fx and inventory management issues tampered the benefit, and will continue to do so through the first half of 2017. We still think the opportunity exists for Nike to continue to blow through historical peaks on its way to a 52% gross margin. But, over the near term there will continue to be volatility as NKE continues to learn from its new distribution paradigm. Some of the forces are outside the company’s control (Fx), but the inventory bloat accentuated by a sales to inventory spread of -6% looks like some severe growing pains caused by owning more of the distribution.


NKE | Full Contact Chess - 6 28 2016 NKE SIGMA


Soft Guidance

Nike guided as softly as a lunarlon insole, taking down 1Q expectations up and down the P&L. Top-line growth estimates disappointed at mid-single digits vs. 9% expected, gross margin assumed down 100bps vs. 80bps of leverage expected, and SG&A up mid to high teens vs. expectations +14%. NA is the biggest contributor to the downward top-line growth revisions (some attributable to NA sporting goods bankruptcies), capped off by FX pressure and unforecastable European softness due to the announced Brexit. SG&A makes sense given the push with the Euro Cup and Brazil Olympics, but we’re more than a bit surprised by the soft gross margin guide as the DTC engine continues to crank.


Looking at the full year, guidance implies growth accelerates in the back half. Overall numbers are relatively in line with consensus expectations with revenue up high single digits, gross margin +30-50bps, and SG&A up high single digits, with gross margin being main divergence, a bit lighter than the expected +70bps. This would imply FY2017 earnings per share growth in the high single digit range, below the prior initial guidance of low teens growth given on the 3Q call when TSA issues were known.  We criticized UA for having to guide down on Sports Authority after reiterating 2016 on it weeks before, but perhaps Nike could have been more proactive when it became apparent its #4 wholesale partner was going away, who appears to have never been mentioned on a conference call.

Home Health Payment Update Takes 1% Reduction - More Change on the Way Neg: LHCG, AMED, KND, HLS

Takeaway: Not great reimbursement news and regulatory visibility drops with expanded discussion of alternative payment model

Yesterday afternoon, CMS released the proposed CY 2017 payment update for home health services. They are proposing that the 60-day episode rate be reduced by $28.44. This impact represents an increase of 2.3 percent for the market basket adjustment less 2.3 percent for the final year of a four-year rebasing, less 0.97 percent for the second of a three year phase-in of a case-mix creep adjustment less a proposed change to the FDL ratio of 0.1 percent.


The most interesting part of the proposal is not the payment rate, however. Annual payment proposals are a time honored venue for floating trial balloons. This year, CMS is floating the idea of a new payment system for home health services called the Home Health Groupings Model. Instead of a system of 60-day episodes that encourage use of therapy services by providers, CMS is floating the idea of 30-day episodes that are grouped by timing in sequence of other episodes, referral source, clinical grouping, functional/cognitive level and comorbid conditions. To be clear, CMS is not making a specific proposal but in this era of the CMMI, the possibility of change within the next two to three years is very real.


Home Health Groupings Model. Policy makers have long complained that the Home Health Prospective Payment System encourages the delivery of therapy services regardless of patient characteristics. Over the years, CMS and Congress have attempted to reduce reimbursement only to be met by margin protection through increased therapy utilization. Last year, CMS conducted research on possible alternative payment models for home health services. The analysis yielded three possibilities as alternatives to the current Home Health Prospective Payment System, including the Home Health Groupings Model


In this year's payment update, CMS expands on last year's disclosure with more information on the HHGM. The features of this alternative model would include:

  • 30-day episodes of care instead of the current 60 days
  • Each episode would then be classified into subgroups based on five different categories: timing, referral source, clinical grouping, functional/cognitive level and comorbidities, yielding 324 possible payment groupings
  • Each payment grouping would be further classified into clinical groups: Musculoskeletal Rehabilitation; Neuro/Stroke Rehabilitation; Wound Care; Medication, Management, Teaching and Assessment (MMTA); Behavioral Health Care; and Complex Medical Care.
  • Each episode would have a functional/cognitive designation that estimated resource use
  • Lastly, the payment grouping would include a designation for comorbid conditions, if any, that further refined resource needs

Clearly, a shift from the current structure of the HHPPS to the HHGM would be a very big change in how CMS pays for home health services. Providers and investors should take this possibility very seriously. In the last year, CMS has spent a good deal of time analyzing claims using the new payment system and plans to issue a Technical Report in the near future along with the ICD-9 and ICD-10 codes assigned to each of the clinical groups that may be included in the HHGM to "to further assist the industry in analyzing the HHGM model."


Time is a precious resource in government and the fact that CMS is spending a good deal of it on HHGM suggests its eventual roll-out as a CMMI demonstration.  We do not believe that will occur until the summer of 2017, at the earliest, but it is a very real and present danger. We have been fans of home health for a number of years but the possibility of a significant change to the payment system means reduced regulatory visibility (similar to our concerns about hospice) and that gives us pause as we await more information.


CY 2017 Payment Update. The base unit of payment for home health services is the national, standardized 60-day episode rate. For each individual episode of care the rate is modified by a case-mix weight and a wage index value. The episode payment can be further modified by a Low Utilization Payment Adjustment (LUPA), a Partial Episode Payment (PEP) and/or an Outlier Payment.


The national, standardized 60-day episode rate is adjusted annually by a wage index budget neutrality factor, a case-mix weight budget neutrality factor and a market basket adjustment that is modified by the a multifactor productivity adjustment. Additionally, the national standardized 60-day episode rate is reduced by $80.95 in CY 2017 to complete a four year rebasing mandated by the Affordable Care Act and a 0.97 percent reduction for the second of three years to account for case-mx creep identified last year. As a result of these adjustments the national, standardized 60-day episode rate will be reduced from $2,965.12 to $2,936.88, assuming the HHA submits quality data as required by CMS. Table 1 illustrates the components of the CY 2017 rate.


Table 1: Proposed CY 2017 National, Standardized 60-day Episode Rate.

Home Health Payment Update Takes 1% Reduction - More Change on the Way Neg: LHCG, AMED, KND, HLS - Home Health Standard Payment

Source: CMS


CY 2017 Low Utilization Payments. When a patient requires four or fewer visits, the HHA is paid on a per visit basis. Whereas the ACA-mandated rebasing reduced the episode rate by $80.95, it had the opposite effect on LUPA visits rates. Proposed increases in LUPA visits range from $6.34 for Medical Social Services to $1.79 for a Home Health Aide, assuming the HHA submits quality data. Table 2 illustrates the proposed CY 2017 LUPA visits.


Table 2: Proposed CY 2017 LUPA Per Visit Payment Amounts

Home Health Payment Update Takes 1% Reduction - More Change on the Way Neg: LHCG, AMED, KND, HLS - Home Health LUPA

 Source: CMS


Nonroutine Medical Supply Payment Rates. Medicare pays for nonroutine medical supplies such as ostemy bags and catheters by mulitplying the relative weight for a particular severity level times a conversion factor. In this final year of rebasing phase-in, the NRS conversion factor is reduced by 2.82 percent and then increased by the market basket adjustment less the multifactor productivity adjustment for an update of 2.3 percent. Table 3 illustrates the proposed CY 2017 NRS conversion factor


Table 3: Proposed CY 2017 Nonroutine Medical Supply Conversion Factor

Home Health Payment Update Takes 1% Reduction - More Change on the Way Neg: LHCG, AMED, KND, HLS - HH NRS

 Source: CMS


Rural Add-on Payment. Since 2004, HHAs that deliver services in rural areas have been received the benefit of an add-on payment. Currently, this add-on payment is three percent and subject to a sunset provision on December 31, 2017. LHCG, which has a significant presence in rural areas has been the beneficiary of this add-on. The payment continues for at least another year and may be extended as it has been a number of times by Congress.


Table 4: Proposed CY 2017 National, Standardized 60-day Episode Rate for Rural Areas

Home Health Payment Update Takes 1% Reduction - More Change on the Way Neg: LHCG, AMED, KND, HLS - HH Rural Addon

Source: CMS


Table 5: Proposed CY 2017 LUPA Per-Visit Rates for Rural Areas

Home Health Payment Update Takes 1% Reduction - More Change on the Way Neg: LHCG, AMED, KND, HLS - LUPA rural rate

Source: CMS

Changes to Reimbursement for Disposable Negative Pressure Wound Therapy Device. Earlier this year, Congress mandated that single use or disposable NPWT devices would no longer be included in the home health episode payment but be paid separately. How that provision came to be included in the Consolidated Appropriations Act of 2016 is probably an interesting back story. The politics notwithstanding, CMS is proposing to pay for single use or disposable NPWT (HCPCS 97607 and 97608) using the Outpatient Prospective Payment System which will reimburse the provider outside of the Home Health Prospective Payment System. The change is good news for home health agencies which now have an new revenue source for these devices that previously had been included in the home health episode payment.




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