Medicare Physician Fee Schedule Cuts Coming in January. Is Help on the Way?

APTA

A new bipartisan bill provides full relief to the 3.4% cuts, but nothing can happen until Congress comes back from recess.

Despite strong advocacy from APTA, the American Medical Association, and more than 100 other patient and provider groups, Congress is likely to leave Capitol Hill without addressing a 3.4% cut to payment under Medicare Part B, closing the last window that would've prevented the cuts from taking effect Jan. 1. With the cuts now almost certain to be implemented, the next opportunity to provide relief will come in January, when Congress must act on government funding by Jan. 17. Fortunately, groundwork has been laid for a needed change, thanks to a recently introduced APTA-supported bipartisan bill that would fully offset the reductions.

The bill, H.R. 6683, introduced in the U.S. House of Representatives, would provide full relief from the cuts, and make that relief retroactive to the Jan. 1 implementation date. APTA has joined with AMA and other provider groups to urge lawmakers to include the legislation in whatever package Congress adopts to fund the government in 2024, and the association is urging members and supporters to voice support for the bill with their lawmakers though the APTA Patient Action Center or Legislative Action Center. Both resources make the process fast and easy.

Support for the legislation in the House is growing. Recently, more than 190 representatives signed onto a letter urging congressional leaders to prevent the cuts, writing that "physicians and other healthcare providers, who are confronting inflationary pressures and workforce shortages, need Congress to prevent this cut, which will add significant burdens to the healthcare infrastructure and the communities they serve."

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Is AI Making Claim Denials in Error? What Does It Matter if We Don't Appeal?

APTA | By Wanda Evans, PT, DPT, MHS

These days, it's hard to escape the attention being paid to artificial intelligence, or AI. The technology is making its way into what seems like every corner of our lives, including in our professional capacities as PTs and PTAs, and in the ways payers make care decisions.

Unfortunately, it's not all good news: This year, two behemoth commercial payers, UnitedHealthcare and Cigna, were challenged with potential class-action lawsuits alleging misuse of AI in ways that negatively impacted patient care. In Cigna's case, the allegations are that the insurer relied too heavily on an algorithm that resulted in a high rate of claim denials. UnitedHealthcare is facing a similar allegation that its algorithm denied needed extended care for older adult patients.

Of course, media coverage of these suits focuses on the use of AI — and to a large extent, that makes sense. But for health care providers and patients, the real issue here isn't about the use of algorithms, no matter how sophisticated. The real issue is about the importance of appealing denials…

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Biden Administration Urges Judge To Throw Out NAHC’s Home Health Payment Lawsuit

Home Health Care News / By Andrew Donlan
 
In July, the National Association for Home Care & Hospice (NAHC) filed a lawsuit against the U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services over home health payment cuts. 
 
On Dec. 15, the Biden administration responded by asking a federal judge to throw out that lawsuit, in a move that NAHC considered a predictable outcome. 
 
“The government’s position in responding to the NAHC lawsuit, as set out in its December 15 brief, was fully expected,” NAHC President William A. Dombi said in a statement shared with Home Health Care News. “Virtually every lawsuit against Medicare includes an effort to dismiss the case on the grounds that the court does not have the power to adjudicate the complaints.”

The lawsuit, pertaining to CMS’ home health payment methodologies, was put forth when NAHC felt like it had “no other option left.” After continued advocacy in Washington, D.C., and attempts at legislation over the previous two years, NAHC felt legal means had to be pursued. 

In 2022, CMS finalized permanent cuts to home health payments. It did the same in 2023. 
 
HHCN has previously broken down some of the viable legal arguments against CMS’ continued cuts to home health payments. 
 
“We continued our conversations, discussions and advocacy with CMS in hopes of seeing something happening in the proposed rule that was issued last week,” Dombi said in July when the lawsuit was filed. “When that rule came out, CMS absolutely stuck to its position on the budget neutrality calculation methodology. It was decided that we really had no other option left to try to deal with that other than to go to court.”…

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2024 Executive Forecast: What 6 Top Home Health Leaders Expect Next Year

Home Health Care News / By Patrick Filbin
 
Staffing shortages, rate cuts and Medicare Advantage penetration will continue to be trends in the home health market in 2024. Those aren’t new. What is new, however, is how providers plan to combat the issues that stem from those trends.
 
Home health leaders are focused on mitigating margin compression, utilizing more technology, leveraging artificial intelligence, working smarter with MA plans and more in the new year.
Home Health Care News heard from six of these home health industry leaders, who shared their views on the biggest trends, challenges and opportunities that will define home health care in 2024 and beyond.
 
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We will continue to see the importance of traditional Medicare in the home health industry with increasing momentum on Medicare Advantage. Data and analytics to drive the value proposition will be an important focus for 2024. It will be essential that the industry has the data and outcomes to show the broader value impact — in addition to capacity, home health provides a more positive patient experience with lower costs.
 
We will continue to see labor challenges impacting market capacity. In addition, the impact to margin of the payer mix and specific payer strategies designed to maximize care will be critical in 2024. Exploring innovative ways to use technology and its effect on potential efficiency and care delivery will continue into 2024 as well.
 
I see home health as a huge driver of cost savings as well as offering better quality of life and outcomes for patients in 2024. The need to convey that to the payer community and the government is important. We should drive for efficiency as a challenge in 2024, but also to unlock opportunity. Care coordination with other important social determinant drivers – like personal care, transportation, meals delivery and physical activity, as well as clinical care coordination with the health system, primary care doctors and emergent referral sources for quality and timeliness of care, will all be important in the upcoming year.
 
There is great opportunity in market growth, as more and more people are in need of home care services. We will look to grow capacity in the market through workforce solutions, efficiency and unique partnerships of care delivery and coordination, all driving more market growth.
 
– Richard Ashworth, president and CEO of Amedisys
 
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Several challenges from 2023 continue to impact home care — most notably, the recently finalized 2024 cuts to Medicare home care reimbursement rates. We will continue to advocate a rollback of these cuts, and with support for our position in Congress, we’re optimistic progress will come.
 
As the labor shortage continues, home care patient referrals continue to go unfilled. Recruiting and retaining talented clinicians is critical. We can expect more flexible hiring approaches including part-time positions, flex-time scheduling and gig labor across the industry.
 
2024 will bring growing emphasis on insurer efficiencies in coordinating home care services. For example, several national health plans are already taking steps to reduce authorization requirements and in a push to consolidate the managed long-term care (MLTC) market. In New York, the state is requiring low-performing MLTC plans to be absorbed into higher-performing plans — a process that’s now underway. Look, too, for insurers to accelerate the shift of dual-eligible Medicaid recipients to integrated Medicare-Medicaid plans — a trend we’re seeing in New York State and among national for-profit Medicare Advantage insurers.
 
Growth opportunities in 2024 include increased linkage of home care patients to community-based mental health providers — a promising option for addressing America’s mental health crisis. The use of technology — including AI — is evolving quickly in home health care to improve patient outcomes, reduce the administrative burden on clinical delivery and improve administrative efficiencies.
 
– Dan Savitt, president and CEO of VNS Health

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