Despite Hardball Tactics With Home Health Providers, MA Plans Have High Gross Margins

Home Health Care News | By Patrick Filbin
 
Insurers are reporting much higher gross margins per enrollee in the Medicare Advantage (MA) market than in other health insurance markets, according to a new Kaiser Family Foundation analysis.
 
At the same time, many Medicare Advantage plans continue to play hardball with home health providers by rationing utilization and offering low rates.
 
The KFF analysis took a look at financial data in four insurer markets: Medicare Advantage, Medicaid managed care, individual (non-group) and fully insured group.
 
In 2021, MA insurers reported gross margins averaging $1,730 per enrollee. That was at least double the margins reported by insurers in the individual/non-group market ($745), the fully insured group/employer market ($689) and the Medicaid managed care market ($768). Source: KFF
 
There is still some margin pressure for MA plans, as the Centers for Medicare & Medicaid Services (CMS) is looking to increase oversight of them and claw back overpayments in the near-term future.
 
While MA pays almost the same as traditional Medicare in a hospital setting, for instance, skilled nursing facilities and home health agencies are often paid far less by MA for services.
 
“Medicare Advantage plans have both higher average costs and higher premiums (largely paid by the federal government) because Medicare covers an older, sicker population,” KFF reported. “While Medicare Advantage insurers spend a similar share of their premiums on benefits as other insurers in other markets, the gross margins — which include profits and administrative costs — of Medicare Advantage plans tend to be higher.”

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CMS PDGM Webinar and Data

CMS has announced a webinar on March 29 that will provide an overview of provisions from the CY 2023 HH PPS final rule, including behavior changes, and payment rate development. They've also released data on simulated 60 day episodes and actual 30 day periods used in their rate setting and adjustments.

Webinar registration, the released data, and additional information can be found here: www.cms.gov/medicare/medicare-fee-for-service-payment/...

Organ Damage for 59% of Patients with Long COVID Continues a Year After Initial Symptoms

By SAGE Publications

A new comprehensive study of organ impairment in long COVID patients over 12 months shows organ damage persisted in 59% of patients a year after initial symptoms, even in those not severely affected when first diagnosed with the virus.

The study, published in the Journal of the Royal Society of Medicine, focused on patients reporting extreme breathlessness, cognitive dysfunction and poor health-related quality of life. 536 long COVID patients were included in the study. 13% were hospitalized when first diagnosed with COVID-19. 32% of people taking part in the study were healthcare workers.

Of the 536 patients, 331 (62%) were identified with organ impairment six months after their initial diagnosis. These patients were followed up six months later with a 40-minute multi-organ MRI scan (Perspectum's CoverScan), analyzed in Oxford.

The findings confirmed that 29% of patients with long COVID had multi-organ impairment, with persistent symptoms and reduced function at six and twelve months. 59% of long COVID patients had single organ impairment 12 months after initial diagnosis.

A member of the research group, Professor Amitava Banerjee, Professor of Clinical Data Science at the UCL Institute of Health Informatics, said, "Symptoms were common at six and twelve months and associated with female gender, younger age and single organ impairment."

The study reported a reduction in symptoms between six and 12 months (extreme breathlessness from 38% to 30% of patients, cognitive dysfunction from 48% to 38% of patients and poor health-related quality of life from 57% to 45% of patients).

Professor Banerjee added, "Several studies confirm persistence of symptoms in individuals with long COVID up to one year. We now add that three in five people with long COVID have impairment in at least one organ, and one in four have impairment in two or more organs, in some cases without symptoms."

He said, "Impact on quality of life and time off work, particularly in healthcare workers, is a major concern for individuals, health systems and economies. Many healthcare workers in our study had no prior illness, but of 172 such participants, 19 were still symptomatic at follow-up and off work at a median of 180 days."

The underlying mechanisms of long COVID remain elusive, say the researchers, who did not find evidence by symptoms, blood investigations or MRI to clearly define long COVID subtypes. They say that future research must consider associations between symptoms, multi-organ impairment and function in larger cohorts.

Prof Banerjee concluded, "Organ impairment in long COVID has implications for symptoms, quality of life and longer-term health, signaling the need for prevention and integrated care for long COVID patients."

Home Health Leads to Higher Costs After Hip Surgery, Study Finds

McKnight’s Long-Term Care News | By Rachael Zimlich
 
Home healthcare services provided after hospital discharge have, in general, been associated with reduced healthcare cost and utilization. A new study examining costs after hip replacement surgery hints that such benefits may be exaggerated.
 
In a new study published in the Journal of Arthroplasty, researchers examined the home healthcare service records of patients who underwent elective hip replacements between 2010 and 2019. The goal was to determine the value of home health services to patients who were discharged to their homes after a total hip replacement.
 
The home health care group had a higher rate of emergency department visits and hospital readmissions in the initial 90-day post-operative period than the self-care group, researchers found. Length of hospital stays and total cost of care a year out from surgery was also higher in the home health care group, according to the report.
 
As part of the study, investigators examined rates of complications such as joint infection and hardware problems for a year after surgery. The primary medical complications observed in the post-operative period were fairly common to other surgeries and included pulmonary embolism, deep vein thrombosis, myocardial infarction, pneumonia, sepsis and urinary tract infection.
 
The study also found there was no significant difference in the development of these complications in the study group discharged with home health care services and the study group that was discharged to their own care.
 
Researchers say the study challenges previously held notions that home healthcare services after hospital discharge are associated with cost savings across the board. Instead, the study suggests that more research be done to examine patient-specific discharge needs, focusing the use of home healthcare services on the most at-risk population instead of assigning this level of care in a one-size-fits all strategy based on a specific diagnosis or procedure type.