In the News

August Recess: A Time to Build Relationships

Establishing relationships with elected officials is the key to effective advocacy. This can seem intimidating, but policymakers want to know their constituents and better understand their voters’ concerns. Consider taking time to contact and educate your legislators. August recess is the best time to establish and build relationships with your US members of Congress since they are back home in their districts. The recess is from July 31 to September 4. Start planning now for a successful outcome. Here are some suggestions:

APTA Action App
Download this extremely valuable tool to advocate. This app serves as a one-stop shop, with features including: a link to the legislative action center, a link to PTPAC to make a donation, visit reports to be used post-advocacy events, a Congressional directory, Advocacy Network signup and other helpful information. It’s a great way to learn about PT issues to help educate members of Congress.

Town Hall Meeting
Attend a town hall meeting. Often members of Congress will hold a town hall meeting where they will discuss important issues that they see as a priority to their Congressional district. Research their Congressional website to find a town hall meeting that is virtual or near you. Look for one focused on healthcare. Consider asking a question or raising issues that they also believe are important.

PT/PTA School Visit or Practice Visit
Organize a visit to your PT/PTA program or private practice. Your campus or practice can host a member of Congress who represents the Congressional district where it is located. They will familiarize themselves on the issues important to physical therapy and share their views. Practices can give tours of their clinics, introduce them to patients, and show a legislator firsthand the value of physical therapy. Don’t hesitate to reach out to their offices. They will be grateful for exposure to potential voters.

District Meeting
Schedule a district office meeting with your US Senators and/or House of Representative. Best to schedule at the end of the recess so that you have enough time to recruit others to join you from different practice settings. Imagine being able to lobby an issue with a PT or PTA from every practice setting giving their patients a voice. You only need to call or email the Congressional office to schedule a 15-minute meeting. They will meet with you since being a constituent makes you an important person.


PT-PAC Fund Raiser
Physical Therapy Political Action Committee (PT-PAC) is the fundraising arm of the APTA. Contact Michael Matlack at [email protected] to see if there are any fund raisers to attend in your Congressional district. If your member of Congress is a co-sponsor of several of our priority issues, there may be dollars for you to attend an event. These events support candidates for office, who support issues that are important to physical therapists, physical therapist assistants and students.

Pick one or two activities this August recess to help advance the profession and provide better care for your patients. Use this August Recess Guide to help you be successful.

Contact Eva Norman, PT, DPT – FPTA Federal Affairs Liaison at [email protected] to share your activities and for any help and support.

Learn *Educate *Advocate
PT & our Patient are Counting on You!

 

CMS Home Health Cuts Could Be More Significant Than Originally Estimated, New Analysis Reveals

Home Health Care News | By Robert Holly

If finalized as is, the home health proposed payment rule for next year could lead to larger cuts than originally estimated.
 
That’s according to an analysis from Homecare Homebase (HCHB), which pulled data from its vast customer base, representing nearly 50% of all Medicare-certified home health visits.

Released on June 30, the FY 2024 home health proposed payment rule from the U.S. Centers for Medicare & Medicaid Services (CMS) includes a 3% market-basket update that’s partly offset by a roughly 0.3% downward productivity adjustment. The agency’s plan also includes a 0.2% increase that reflects the effects of a proposed update to the fixed-dollar loss ratio used in determining outlier payments.
 
Added up, those figures produce a 2.9% increase in home health payments for 2024. That positive number, however, is offset by a whopping 5.1% cut from CMS, which believes it has to permanently adjust payments under the Patient-Driven Groupings Model (PDGM) to maintain budget neutrality, as mandated by the Bipartisan Budget Act of 2018.
 
The way the math currently works out, CMS estimates that its proposed payment rule would represent an aggregate cut of 2.2% next year, or about $375 million less compared to 2023 levels.
 
Broadly, CMS says it needs to make permanent adjustments to home health payment mechanics because providers adapted to PDGM in a way that’s different from how the agency assumed providers would behave under the model. Those behaviors are largely related to how agencies document and code for their patients’ functional-impairment levels, their number of clinical comorbidities and more.
 
“In the CY 2023 HH PPS final rule, using CY 2020 and 2021 claims, CMS finalized a methodology for analyzing the differences between assumed versus actual behavior changes on estimated aggregate expenditures and calculated levels of actual and estimated aggregate expenditures,” the agency wrote in a June 30 fact sheet. “Based on analyses of CYs 2020 and 2021 claims data, CMS determined a permanent adjustment was needed.”
 
But after doing its own numbers crunching, HCHB estimates that the 2024 cut could be even greater than 2.2%.
 
“In terms of HCHB’s methodology, as soon as the proposed rule is released, our regulatory and analytics teams immediately begin reviewing every detail of the rule and updating our ongoing models,” HCHB Chief Strategy Officer Scott Pattillo told Home Health Care News in an email. “Once the new model is complete and has been thoroughly tested, we take all the claims for 2023 (year-to-date) and run them through the proposed 2024 model. Then we compare the actual reimbursement in 2023 to the modeled reimbursement for 2024.”
 
After analyzing reimbursement by standard periods, Low Utilization Payment Adjustments (LUPAs), outlier payments, wage-index changes and other factors, HCHB estimates aggregate total home health payments next year could be trimmed by as much as 2.66%.
 
“This year’s results show that, if agencies saw the exact same patients and performed the exact same services, they would be paid 2.66% less for those patients in 2024 than in 2023,” Pattillo explained.
 
While a difference between the CMS and HCHB estimate may seem small, it ultimately could translate into several million dollars of home health payments.
 
Senior Director of Product Management Andy Guarnera and Product Manager Benjamin Hayes, both in the data analytics department of Homecare Homebase, helped spearhead the analysis.
 
Not equal for everyone
 
Pattillo was careful to point out that the proposed payment adjustment for next year wouldn’t be equal for everyone.
 
“Each of our customers has their own unique results,” he said. “While we cannot share the details by agency, we can share some ranges.”
 
Unique to this proposed rule, Pattillo noted, is that every state will see a cut, which hasn’t always been the case. Yet some states will be barely impacted at all, while others could receive an almost 6% cut.
 
“Agency results show a wide range from -6% for a few, to up to a 3.6% increase,” Pattillo said. “The biggest drivers of this variance are case mix and wage index.”
 
Generally, the greatest drivers of this year’s potential cut in terms of real impact are the reduction in standard payment and case mix, which is slightly offset by the increase in outlier revenue.
 
“Based on HCHB’s very large sample, we would expect this -2.66% to be representative of the aggregate impact to the whole industry,” Pattillo said.

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Ask Your Senators to Support Preserving Access to Home Health Act

The Centers for Medicare & Medicaid Services has made drastic cuts to home health that will reach approximately $20 billion in the next ten years. 

Cuts of this magnitude will threaten the ability of nearly 3 million Medicare beneficiaries to receive clinical nursing and therapy care services in the home each year.

Fortunately, Congress is taking action. Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) recently introduced the Preserving Access to Home Health Act (S. 2137) to prevent CMS from implementing these dire cuts.

This legislation is immediately needed to protect the future viability of the Medicare home health program, and we need your help to get this legislation passed. Send an email to your Senators today urging them to support this vital legislation.

Send a Message Now! (Customize or Use the Provided Form Letter)

 

Beyond The Cuts: What Else Home Health Providers Need To Know About CMS’ Proposed Rule

Home Health Care News | By Patrick Filbin
 
When the U.S. Centers for Medicare & Medicaid Services (CMS) published its FY 2024 home health proposed payment rule, the 2.2% cut immediately became the focus.
But the nearly 300-page rule included dozens of other notable, proposed changes to home health care.
 
From Home Health Value-Based Purchasing (HHVBP) Model tweaks to a more focused approach on health equity, there are a number of developments that home health providers and stakeholders are keeping an eye on.
 
HHVBP
One of the major changes CMS included in the proposed rule deals with HHVBP.
Most notably, CMS is proposing to remove five quality measures and add three to the applicable measure set starting in 2025.
 
The three additions are around discharge function scores, discharges to the community and potentially preventable hospitalizations during home health care coverage.
 
“There are some significant updates to the VBP, not the least of which is the highest measure, which is currently acute care hospitalizations,” Nick Seabrook, managing principal and SVP of consulting at SimiTree, told Home Health Care News. “CMS is changing that now to potentially preventable hospitalizations. This may be the way to help offset that dynamic where, if you’re an agency that is hospital-based, you may have a higher rehospitalization rate because of the nature of the patients you take and their acuity.”
 
The new potentially preventable hospitalizations benchmark, Seabrook said, is CMS’ way of introducing a new algorithm that will try to level the playing field across the industry.
Another reason why that change is critical for home health providers to pay attention to is the weight of that measure in the overall VBP calculation.
 
“It’s still being proposed that 26% of your VBP score is weighted towards that one specific measure,” Seabrook said. “If you’re going to focus on any measure on your value-based purchasing measures, it’s going to be that one.”
 
Another change includes replacing the OASIS-based discharge-to-community measure with the claims-based discharge community post-acute care measure…

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APTA Guide to Physical Therapist Practice 4.0

The APTA Guide to Physical Therapist Practice is the description of physical therapist practice, for use by physical therapist and physical therapist assistant educators, students, and clinicians.

  • Guide History: See how the Guide got its start, the work involved in its development, and where it is today.
  • Permissions: Review terms and conditions for use of the Guide. 
  • Subscriptions: APTA offers individual and institutional subscriptions.
  • Educator Module: This is a tool to facilitate teaching the concepts of the Guide to Physical Therapist Practice.
  • Advocacy Module: This information is in the Guide to Physical Therapist Practice to assist policy makers to understand the importance of physical therapists within the health delivery system.

Access the guide here.

 
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