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Bipartisan House Lawmakers Introduce Preserving Access to Home Health Act to Protect Patients from Harmful Home Health Program Cuts

PQHH-NAHC Press Statement
New report underscores need for policies to ensure timely patient transition to home health following hospitalization 
Washington, D.C. – The Partnership for Quality Home Healthcare (PQHH) and the National Association for Home Care & Hospice (NAHC) today commended Representatives Terri Sewell (AL-7) and Adrian Smith (NE-3) for introducing the Preserving Access to Home Health Act of 2023 in the U.S. House of Representatives. If enacted, the bill would safeguard access to essential, home-based, clinically advanced healthcare services by preventing the Centers for Medicare & Medicaid Services (CMS) from implementing cuts as high as $20 billion over the next decade.
“The Medicare home health community strongly supports this legislation and thanks Representatives Sewell and Smith for their leadership on a Medicare issue that truly threatens access to care for the more than 3 million beneficiaries who rely on this care,” said William A. Dombi, President of the National Association for Home Care & Hospice. “The home health community calls on Congress to ensure the stability that patients and providers urgently need. Since Medicare has again proposed deep cuts to home health in 2024, Congress must act to protect the care their constituents prefer and want.”
Specifically, the bill is designed to address cuts made to home health by CMS during the implementation of Medicare’s Patient Driven Groupings Model (PDGM) by making the following policy changes:

  1. Repealing permanent and temporary Medicare payment adjustments. The bill would repeal the requirement that CMS make determinations related to the impact of behavior changes on estimated aggregate expenditures. The legislation would eliminate CMS’s authority to adjust home health payments based on such determinations under PDGM. This change would take effect, and be implemented, as if it were included in the Bipartisan Budget Act of 2018, which included home health provisions that led to PDGM implementation.
  2. Instructing MedPAC to analyze the Medicare Home Health Program. The bill instructs MedPAC to review and report on aggregate trends under Medicare Advantage, Medicaid, and other payers and consider the impact of all payers on access to care for Medicare home health beneficiaries. To verify MedPAC’s calculations, the Commission would be required to make its calculations public. This provision would also add requirements for Medicare home health cost reports to include data on visit utilization and total payments by program.

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CMS Unveils Dementia-Focused Payment Model with Interdisciplinary Care Approach

Hospice News | By Jim Parker

The U.S. Centers for Medicare & Medicaid Services (CMS) has unveiled a new payment model demonstration geared toward dementia-related illnesses, which are becoming more prevalent among hospice patients.

The Guiding an Improved Dementia Experience (GUIDE) Model is designed to improve the quality of life for dementia patients and their caregivers by addressing behavioral health and functional needs, as well as better coordinating care and improving care transitions between community, hospital and post-acute settings.

“While we have made tremendous progress in improving care for people with dementia through the National Plan to Address Alzheimer’s Disease, people living with dementia and their caregivers too often struggle to manage their health care and connect with key supports that can allow them to remain in their homes and communities,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden.”

Participating patients and families will also have access to a care navigator to help them access clinical and non-medical services.

Patients will be stratified into one of five tiers, based on a combination of their disease stage and caregiver status. Care intensity and payment increase by tier, according to CMS.

Reimbursement through the model includes a per-member, per-month payment, as well as an infrastructure payment for some safety net providers. Participating operators may also receive payment for respite care.

Patients who have elected the Medicare Hospice Benefit are not eligible for the program. However, hospice and palliative care providers that offer upstream services may be uniquely suited to implement such a model, either directly or through a partnership.

GUIDE involves a trained interdisciplinary care team that delivers a standardized set of services based on a person-centered care plan, according to CMS.

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GUIDE Webinar

CMS will host a webinar to provide more information on the GUIDE Model. During the session, the GUIDE team will discuss the goals of the model, participant and beneficiary eligibility criteria, care delivery requirements, and model payment.

  • Date: Thursday, August 10 at 2 p.m. – 3 p.m. ET
  • Registration: To register, click here

Interested in GUIDE? 


Referral Rejection Rates, Patient Complexity In Home Health Care Reaching All-Time Highs

Home Health Care News | By Andrew Donlan

While referrals to home health care are ballooning, providers are rejecting them at an unprecedented rate.
As hospitals scramble to place patients in the hands of appropriate post-acute care providers, skilled nursing facilities’ referral volume has rebounded.
Home health referral volume also remains above pre-pandemic levels, but providers are struggling with staffing challenges and sicker patients. Data from WellSky’s 2023 Evolution of Care Report shows just how significant those issues have become.
“We’re entering a new era of care delivery and there is a dramatic shift happening in the health care landscape,” Lissy Hu, president of connected networks at WellSky, said in a statement. “Providers, whether it’s the hospital or the doctor’s office, and health plans need to be connected to post-acute and home-based providers as care shifts to home and value.”
In April, Hu told Home Health Care News that referral rejection rates “very much remained an issue” at a time when home health referrals were at an all-time high.
“Our data shows that it’s truly a care continuum – that what happens in the post-acute setting has a direct impact on the hospital setting and vice versa – so improving patient outcomes requires a holistic cross-continuum approach,” she continued.
Specifically, 76% of patients being referred to home health care were not being accepted as of December 2022. That number was up from 54% in 2019.
WellSky’s data analysis is based on proprietary data that draws from over 2,000 hospitals and 130,000 post-acute care providers.
This issue has forced providers to be more up front with their referral partners in recent years, acknowledging which patients they can take and which patients they can’t.
“You just need to be transparent,” Geoffrey Abraskin, a senior vice president at Amedisys Inc. (Nasdaq: AMED), told Home Health Care News. “If you’re truly in a partnership, there’s going to be an understanding. Just like hospitals go on diversion – if their ED is full, for example – home health does the same thing. So, we’re in the same boat as them. We just try to be very proactive and upfront with our capacity or limitations.”
Home health providers are also caring for more complex patients than ever before.
WellSky data shows that patients are now at least 6% more acute, on average, than they were in 2019 at discharge.
Patients are more likely to be experiencing neurological, alcohol-use and drug-use disorders. They are also more likely to be suffering from psychosis or pulmonary circulation diseases.
“Anecdotally, we’ve been seeing that for years,” Bud Langham, EVP of clinical excellence and strategy at Enhabit Inc. (NYSE: EHAB), told HHCN earlier this year. “It started a long time ago, but certainly accelerated during COVID because there were fewer inpatient beds and staff to take care of those patients. In the home health industry, we were asked to take care of patients who were sicker than what we were used to.”


Study Highlights Physical Therapy’s Clinical, Financial Benefits Among Medicare Beneficiaries

Home Health Care News | By Patrick Filbin
Increased physical therapy (PT) utilization is associated with significant reductions in hospitalizations and emergency room visits, more evidence shows.
Meanwhile, home health providers are still grappling with how to manage physical therapy under the Patient-Driven Groupings Model (PDGM).
A new study from the Alliance for Physical Therapy Quality and Innovation (APTQI) showed that an increase in PT among Medicare patients could reduce health care spending by $10 billion.
PT users were 50% less likely to visit the emergency room or be hospitalized for a follow-up injury in the six months following their initial fall, according to the study.
An important distinction, however, is that the data tracked users who had already experienced a fall.
“A lot of people are going to end up in home health because after you fall, you may be homebound for a bit,” Nikesh Patel, executive director of APTQI, told Home Health Care News. “I think what this shows is that whatever setting those PT sessions are happening post-fall, you’re going to have a significant decrease in the likelihood of falls in the next six, 12 and 18 months.”
The results confirm what physical therapists have known for a long time, Patel said: that PT is a safe and effective method for helping seniors build the strength and other necessary skills to avoid future falls and reduce costly expenditures.
The U.S. Centers for Medicare & Medicaid Services (CMS) implemented PDGM on Jan. 1, 2020. Prior to PDGM, home health agencies were paid per therapy visit under the home health benefit in Medicare Part A. Now, payment is tied to patient characteristics.
At the beginning of 2020, many believed there would be an inevitable disruption to home health therapy utilization.
Today, it’s still unclear exactly how PDGM has impacted therapy utilization. Following the implementation of the new payment model, providers were naturally less likely to offer therapy services because they were not as incentivized to do so.
The study’s findings are another example of how PT can offer savings to the entire health care sector.
“For me, the most telling statistic was that for every 100 Medicare beneficiaries, we average in the U.S. about 21 hospital stays,” Patel said. “Of those hospital stays, 40% of those are fall-related. If you have a decrease of four to six hospitalizations and inpatient stays for a year, the costs are staggering.”
According to the study’s authors, increased PT use by 100 beneficiaries prone to falls could result in an offsetting reduction in total health care spending of as much as $61,400 to $91,900 per member.
When considering the 13.5 million Medicare beneficiaries who are not enrolled in physical therapy, that could create $10 billion in savings.


Study: Older Dementia Patients Go to ER Twice as Often as Other Seniors

Washington Post | By Erin Blakemore
Older people with dementia seek care in the emergency room twice as often as their peers, a new analysis suggests — leading to what researchers call “potentially avoidable and harmful visits” for some patients.
The study, published July 24 in JAMA Neurology, examined data from the 2016-2019 National Hospital Ambulatory Medical Care Survey, which collects demographic and other information about a nationally representative sample of ER visits. About 1.4 million of the annual 20.4 million ER visits among adults over 65 involved patients with Alzheimer’s disease and related dementias, researchers found.
Patients with dementia presenting at the ER were more likely to be age 85 or older and female. The most common reasons for seeking care were accidents (7.9 percent), behavioral disturbances (7.4 percent) and general weakness (5.3 percent).
Once they got to the ER, patients with dementia were likelier to receive diagnostic tests such as CT scans and urinalysis — perhaps because of communication issues or behavioral concerns. They also were twice as likely to receive antipsychotic medication, which is cause for concern, the researchers write, because of the risks of taking such drugs and the potential for them to continue being used long-term. (Antipsychotics are associated with higher mortality risk and life-threatening falls in older adults.) They were less likely to be prescribed opioids than their counterparts.
The statistics reflect challenges in the daily lives of people with dementia, who may behave erratically and often cannot communicate about their symptoms. Despite these challenges, the study says the ER is often not the best place to care for adults with dementia due to long wait times, unfamiliar staff and a potentially disorienting environment.
The researchers call for better caregiver supports and the development of more geriatric-friendly emergency rooms, although they acknowledge that in some situations emergency care is needed.
“While dementia is thought of as a cognitive or memory disorder, it is the behavioral aspects of the disease such as anxiety, agitation and sleep disturbances that can cause the most stress for caregivers and patients alike,” study co-author Lauren B. Gerlach, a geriatric psychiatrist at Michigan Medicine and an assistant professor in psychiatry at the University of Michigan, said in a news release.
“Emergency departments are often not the right place to manage these behaviors,” she added. “We really need to do better to support caregivers so there are options other than seeking emergency care.”

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