In the News

Home Health Providers Take Aim At CMS’ ‘Black Box’ Approach To Policymaking

Home Health Care News | By Joyce Famakinwa
 
Enough time has passed since the CY 2024 home health payment rule was finalized for providers to dive into its details, mull them over and respond. 
 
Though the rule is more favorable than the proposal the U.S. Centers for Medicare & Medicaid Services (CMS) first introduced in June, home health providers are not pleased with the final outcome. 
 
CMS didn’t address – and in some cases furthered – the concerns that many providers and industry stakeholders raised in the months and weeks leading up to the rule’s finalization. 
The rule comes with a 0.8%, or $140 million, aggregate increase to home health payments. In June, CMS proposed a 2.2% aggregate decrease for 2024, which would have been an aggregate decrease of $375 million. 
 
Plus, the rule finalized a -2.890% adjustment, which is half of the cut originally proposed back in June. 
 
“My initial reaction was that where we landed was an improvement over what was proposed,” Choice Health at Home CEO David Jackson told Home Health Care News. “I believe home health provides substantial economic upside for the Medicare program and for the beneficiaries. I continue to disagree with the methodology, as far as how it’s viewed as budget neutral.” 
 
When the rule was first released, some providers felt that relief. But that quickly wore off.
 
“I quickly came to the stark realization that CMS still was continuing with deep cuts — albeit they were kicking them down the road — despite the prevalence of respected third-party data highlighting that cuts have made problems with access to care a reality, not just an assumption,” David Totaro, chief government affairs officer at Bayada Home Health Care, told HHCN. 
 
Similar to Totaro and Jackson, other providers have voiced pushback to what they believe is CMS doubling down on its intention to implement the permanent adjustment cuts in the coming years. 

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Home Health Providers Are Beginning To Tie Clinician Compensation To Value-Based Care Success

Home Health Care News | By Patrick Filbin

Home health providers are adjusting their operations to be better set themselves up for value-based care.
 
One thing they need to be sure of, though, is that those adjustments are making their way down to the front line.
 
“From an agency standpoint, providers are thinking as their reimbursement model changes, how are we being judged against competitors and how are patients choosing us?” Jonathan Dickinson, senior manager of financial consultation with SimiTree, told Home Health Care News. “They’re noticing that a lot of it is based on quality. Value-based purchasing is going to impact their revenue. Now they’re starting to ask themselves, ‘How do we then incentivize our clinicians who are doing the work in the field to emphasize that quality?”
 
Operationally, providers are shifting to models – both inside fee for service and outside of it – that require better quality of care, sometimes with fewer visits.
 
But that message needs to make its way down to the frontline workers.
 
“Providers are saying, ‘You’re giving us great quality as a clinician — even though you may do 10 visits or less a month — we’re still going to pay you the same incentive,’” Dickinson said. “Because the quality is going to drive our reimbursement. We typically are seeing this more as a quality incentive around a quarterly bonus.”
 
For example, a provider could pay a clinician $30 for every visit after their goal in a quantity-based incentive program.
 
Now, providers are paying clinicians $10 for every additional visit and the other $20 is tied to quality incentives that go back to a patient’s outcome.
 
“If you have a clinician who continually just says, ‘I’m just going to do visits and not care about quality,’ they’ll still get a small portion of incentive and revenue, but it won’t be as big as if they were to actually drop back the number of visits and do more quality work,” Dickinson said.
To execute this type of plan, communication is paramount.
 
The more an agency can articulate how the quality of care is tied to compensation, job security and the overall health of the business, the better off everyone will be.
 
“The more an agency can correlate the fact that winning on value protects their jobs and allows them to have compensation increases, the more they’ll be able to understand how this actually impacts them,” Frontpoint Health CEO Brent Korte told HHCN. “It deeply impacts them.”
Based in Dallas, Frontpoint is a home health and hospice company that specifically tailors its business model to take on Medicare Advantage (MA) patients. It’s also betting big on value-based arrangements.
 
At the end of the day, agencies can’t pay clinicians more when they don’t have the money to spend, Korte said.

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How Home Health Providers Can Play A Greater Role In Reducing ED Visits

Home Health Care News | By Patrick Filbin

In order to reduce emergency department visits, home health care providers should be honing in on relationships with primary care providers and patients. 
 
That is the thesis of a new wide-ranging study conducted by researchers and clinicians at the University of Virginia Health. 
 
“The increasing number of home health referrals after ED use in order to improve the transition from hospital to home points to the role that home health care providers can and should play in communicating with PCPs,” Catherine Harris, director of Continuum Home Health at the University of Virginia, said at the National Association for Home Care & Hospice’s (NAHC) annual conference last month. “Providers should be playing a larger role in educating and assisting patients with fostering a strong PCP relationship for health maintenance and prevention.”
As a way to investigate home health care’s role in reducing unnecessary ED visits for seniors, Harris and her colleagues investigated the prevalence of ED utilization among a group of home health patients. 
 
The study reviewed 233 emergency department visits made by 195 home health patients and tried to pinpoint why patients made visits to the ED, whether or not those visits came before or after an in-home visit and if they had admitted themselves to the ED or if a home health aide recommended an ED visit. 
 
The study found that 130 of those patients visited the ED after hours, meaning those visits likely were costlier and less convenient for hospital staff and for the patient. Meanwhile, 149 patients had spent between 1 and 8 hours at the emergency department. 
 
“I have no doubt that our robust attempt to handle these calls and have our staff call the patient back is one of the reasons why so few of these were actually happening during office hours,” Harris said. “We found it fascinating that the vast majority,85, were in the ED for less than four hours — which speaks to the fact that they went in, they got turned around, they got dealt with for whatever that one issue was, and then they were sent back home.”
 
Of the 233 ED visits, 202 were sent home, while 30 were held for further observation. 

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A New Biden Proposal Would Make Changes to Advantage Plans for Medicare: What to Know

USA TODAY | By Maureen Groppe

WASHINGTON − The Biden administration wants to make changes to private Medicare insurance plans that officials say will help seniors find plans that best suit their needs, promote access to behavioral health care and increase use of extra benefits such as fitness and dental plans.

“We want to ensure that taxpayer dollars actually provide meaningful benefits to enrollees,” said Health and Human Services Secretary Xavier Becerra.

If finalized, the proposed rules rolled out Monday could also give seniors faster access to some lower-cost drugs.

Administration officials said the changes, which are subject to a 60-day comment period, build on recent steps taken to address what they called confusing or misleading advertisements for Medicare Advantage plans.

Just over half of those eligible for Medicare get coverage through a private insurance plan rather than traditional, government-run Medicare.

Here’s what you need to know.

Extra Medicare Benefits

Nearly all Medicare Advantage plans offer extra benefits such as eye exams, dental and fitness benefits. They’re offered at no additional cost to seniors because the insurance companies receive a bump up from their estimated cost of providing Medicare-covered services.

But enrollees use of those benefits is low, according to the Centers for Medicare and Medicaid Services.

To prevent the extra benefits serving primarily as a marketing ploy, the government wants to require insurers to remind seniors mid-year what’s available that they haven’t used, along with information on how to access the benefits.

“The rule will make the whole process of selecting a plan and receiving additional benefits more transparent,” Becerra said.

Broker Compensation Limits

Because many seniors use agents or brokers to help them find a Medicare Advantage plan, the administration argues better guardrails are needed to ensure agents are acting in the best interest of seniors. Officials said the change would also help reduce market consolidation.

“Some large Medicare Advantage insurance companies are wooing agents and brokers with lavish perks like cash bonuses and golf trips to incentivize them to steer seniors to those large plans,” said Lael Brainard, director of Biden’s National Economic Council…

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2023 RIHC Home Care Chartbook, Co-Sponsored by NAHC

The Institute is excited to announce the 2023 RIHC Home Care Chartbook is now available online! 

Highlighted by data on Medicare Advantage home health patients, workforce trends, and more, the Chartbook is an invaluable tool for understanding the role home care plays in the U.S. healthcare landscape. 

Released annually, the Chartbook, co-sponsored by the National Association for Home Care & Hospice (NAHC), and compiled and charted by KNG Health Consulting LLC, summarizes and analyzes statistics on home health from a range of government sources. The Chartbook offers a glimpse of home health patients, the home health workforce, organizational trends, and the economic contribution of home health agencies. The Chartbook includes updated statistics from the Bureau of Labor Statistics, the U.S. Department of Commerce, Medicare Cost Reports, Home Health Compare, Medicare fee-for-service claims, the Medicare Current Beneficiary Survey, and other data from CMS. 

We would like to thank 2023 Chartbook sponsor NAHC for their continued support of the Institute and the Chartbook. Learn more about NAHC at www.nahc.org.

A copy of the 2023 RIHC Home Care Chartbook is available here

Please join us for a webinar with the team from KNG, along with our co-sponsors at NAHC, on Wednesday, December 6th at 2 pm ET. Register now here.

For more information on the Chartbook, please reach out to the Institute's Executive Director, Jen Schiller, at [email protected] or (771) 203-0595.

 
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