Annual Report on Medicare Financing Could Reduce the Immediate Impetus to Address Longstanding Issues
Healthcare Financial Management Association | By Nick Hut
Even though the latest actuarial analysis arguably diminishes the short-term urgency surrounding the program, stakeholders see ample reason to act quickly.
New data on the state of Medicare funding show short-term improvement while keeping the stakes high for ensuing decades.
The annual report from Medicare’s trustees shows the Hospital Insurance Trust Fund (i.e., Medicare Part A) has enough money to keep beneficiaries covered and providers paid through 2036. That’s an increase of five years from the 2023 report and eight years from the 2022 projection.
In the unlikely event policymakers ever allow insolvency to happen, providers would incur an immediate 11% reduction in Medicare payments. From there, “Medicare could pay health plans and providers of Part A services only to the extent allowed by ongoing tax revenues — and these revenues would be inadequate to fully cover costs,” the trustees’ report states. “Beneficiary access to healthcare services could rapidly be curtailed.”
The improved short-term outlook is based on higher income stemming from increases in the number of covered workers and in average wages. In addition, expenditures are lower than previously projected, in part because of a change instituted by CMS to constrain Medicare Advantage (MA) payments by excluding MA-associated medical education expenses from benchmark calculations.
Updated number-crunching also has resulted in lower projections for spending on inpatient care and home health services as the trustees phase out some of the mathematical adjustments that were applied during the COVID-19 pandemic.
Nonetheless, Medicare fee-for-service (FFS) inpatient payments are anticipated to rise by 2.3% this year, 2% in 2025, and then by 5.4%-5.5% per year through 2029. The jump during the latter part of that window partially would be linked to a projected deceleration in the shift from FFS to MA.
A drag on the economy
Medicare costs are projected to comprise 3.9% of GDP in 2025, up from 2.19% in 2000, although the 2025 number is down from a projected 4.13% in last year’s report. Within a decade, the figure is expected to reach 5.3%.
“I wouldn’t put that much stock in the trust fund number per se,” Michael Chernew, PhD, professor of healthcare policy at Harvard Medical School, said during a May 7 webinar hosted by the Committee for a Responsible Federal Budget (CRFB). “I think the bigger issue with Medicare is just the overall burden that the program is placing on the economy.”
That strain is expected to grow over the long term, reaching 6.2% at the end of the 75-year window examined in the latest report...
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CMS to Extend Review Choice Demonstration by Five Years, to Remove One of Three Choices
McKnight’s Home Care | By Liza Berger
The Centers for Medicare & Medicaid Services will be extending the Review Choice Demonstration (RCD) for Home Health Services for an additional five years, effective June 1, CMS said on the Home Health, Hospice & DME Open Door Forum call on Wednesday. The demonstration will continue in the states of Illinois, Ohio, Texas, North Carolina, Florida and Oklahoma, an official said.
“This demonstration establishes the review choice process for home health services to assist in developing improved procedures to identify and prevent fraud, protect beneficiaries from harm, and safeguard taxpayer dollars to empower patients while minimizing unnecessary provider burden,” CMS said in a FAQ sheet about the model, which began on June 1, 2019. “The demonstration helps ensure that the right payments are made at the right time for home health service through either pre-claim or post-payment review, protects Medicare funding from improper payments, reduces the number of Medicare appeals, and improves provider compliance with Medicare program requirements.”
There have been three initial choices for agencies under the demonstration, which was slated to end on May 31. As part of the extension, CMS is removing Choice 3: Minimal Review with 25% Payment Reduction from the selections. Two remain: pre-claim review and post-payment review. Palmetto GBA, which administers Part A and Part B Medicare fee-for-service claims, will be reaching out to small numbers of affected providers to select from the two remaining choices, the CMS official said on the call. Selection will start on June 17 and remain open until July 1.
“Providers who do not make an initial review choice selection will default to participate in Choice 2: Postpayment Review,” CMS said on its website about the demonstration’s extension. “Providers with less than 10 reviews at the conclusion of the current cycle, will have their results included in the next cycle’s results.”
All other home health providers in the demonstration will continue in their current review cycles and follow their regular cycle timelines. Providers who believe their current review choice presents a “hardship” and would like to change their choice should notify Palmetto by June 14, CMS stated on the website. |
Uber Reveals New Product to Help Caregivers and Home Health Agencies
McKnight’s Senior Living | By Adam Healy
Rideshare technology firm Uber recently announced a new service aimed at addressing the logistical challenges faced by family members and home care agencies when providing care for older adults aging in place.
Uber Caregiver, revealed last week, will allow users to designate a primary caregiver who can request transportation and deliveries on the user’s behalf. The service aims to alleviate some of the logistical burdens of caregiving, like coordinating rides to appointments or arranging grocery deliveries.
“The notion here is to be able to engage a caregiver in a loved one’s care journey,” Zachary Clark, chief growth officer of Uber Health, told McKnight’s Home Care Daily Pulse in an interview. “We’re really kind of cognizant and aware of the 50 million Americans across the United States that identify themselves as caregivers.”
He added, “If the care receiver isn’t an Uber user today, but Mom and Dad or a sibling is, this is a way to kind of help an individual navigate [their care].”
The service will begin rolling out by late July or early August, Clark said. By the end of 2024, Uber Health plans to add tools like over-the-counter medicine delivery capabilities to the Uber Caregiver platform. The company has already ventured into health product delivery services; Uber recently partnered with Reperio, a technology startup, allowing drivers to deliver health screening kits to and from patients’ homes.
Users will also be able to use healthcare benefits to pay for Uber Caregiver services. Uber Health is working with Medicare Advantage, Medicaid and commercial payers to allow their members to use their plan’s benefits to order rides or deliveries. This feature also gives consumers better visibility into their health plan’s offerings, which can often be confusing to navigate, Clark noted.
“You might be accessing an Uber, but that benefit might be managed through a third party broker. We want to be able to tell you that you have 22 out of your 24 rides left,” he explained. “Today all of that information resides in disparate places. And so combining that in a way that helps engage the member around what they have access to, we think, can be really powerful to create the right kinds of utilization that really we should see of these benefits. “
Home care and home health providers are uniquely positioned to use Uber Caregiver to their advantage, Clark said. The platform can make it easier for patients to engage with care services, he noted. It also allows family members to take a more active role in their loved one’s care, thereby reducing providers’ time spent on tasks like coordinating rides and deliveries, and increasing their opportunities for face-to-face interaction.
“Over time, it reduces the administrative burden for a home health or home care agency carries with them,” Clark said. “So by inviting the caregiver into that experience … it requires less of that home health or personal care coordinator over time, which helps them be more efficient and spend more time with the patient.” |
New Episode Alert: Dive into Episode 4 of 'Home on the Go'
SEASON 1 EPISODE 4 - OUT NOW! 
Whether you’ve been a home health P.T. for 6 months or 20 years, a sense of burnout can happen along the way. Administrative requirements, productivity expectations, professional isolation, and patient/family social dynamics are just a few of the stressors P.T.s may experience while on the job. Responsibilities encountered outside of work such as caring for children or an aging parent may lead to a sense of being in fight-or-flight mode 24/7.
This podcast dives into the research behind burnout and concludes with strategies P.T.s can use to avoid exhaustion, depersonalization, and reduced personal accomplishment during their career.
Click Here to Listen Now! |
Debbie Stabenow, Susan Collins Advocate Against Home Health Payment Cuts In Letter To CMS
Home Health Care News | By Andrew Donlan
Sens. Debbie Stabenow (D-Mich.) and Susan Collins (R-Maine) recently sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, urging her and the agency to avoid cuts to home health payment as it nears time to release a proposed rule for 2025.
“We appreciate CMS’ commitment to helping people get the care they need, where they need it.
This must include home health services for people with Medicare,” the senators wrote. “As CMS proceeds to develop Medicare home health payment rates for 2025, we urge you to consider the value home health care provides to the Medicare program and its beneficiaries.”
Generally, the home health payment rule proposal comes out sometime in June, with the final rule coming out at some point in late October or early November.
Since the implementation of the Patient-Driven Groupings Model (PDGM) in 2020, home health providers have seen steep and permanent cuts to payment. For instance, over the last two years, providers have seen cuts of 2.890% and -3.925% materialize.
“We are concerned that CMS recently finalized home health payment methodology that has led to steep cuts, essentially canceling out market basket updates intended to help Medicare payments keep up with inflation,” the senators continued. “Under this methodology, Medicare home health payment rates have been stagnant over the past three years, and CMS has indicated that further cuts are planned.”
The Partnership for Quality Home Healthcare (PQHH) released a data brief to illustrate how severe the cuts’ impact would be over the next five years – if not mitigated – in late April.
On Friday, PQHH commended Stabenow and Collins for taking action.
“Senators Stabenow and Collins are true champions for Medicare home health, and we applaud their continued leadership to protect the Medicare benefit and access to home-based healthcare for older Americans,” PQHH CEO Joanne Cunningham said in a statement. “We urge CMS to listen to the Senators’ advice to ensure beneficiary access to home health is prioritized in their rulemaking.” |
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