The report found that patients receiving care through the program differed demographically from those at traditional inpatient facilities. Generally, hospital-at-home (HaH) patients were more likely to be white, live in urban areas, and less likely to receive Medicaid or low-income subsidies. These differences may be due to the criteria established by participating hospitals to identify suitable patients for this type of care.

Patients receiving care at home generally experienced fewer catheter-associated urinary tract infections. Mortality rates were also lower. Those with less complex respiratory and infectious conditions had lower 30-day readmission rates than those in traditional inpatient settings. However, readmission rates for patients with more complex respiratory infections were higher for those receiving care at home.

The study found that patients receiving care at home through the initiative resulted in lower Medicare spending during the 30-day post-discharge period. Furthermore, even though at-home patients received the same services as those in traditional hospital settings, they used fewer of the same services. This suggests that hospitals experience lower costs over time when providing care to patients in their homes.

The study also revealed that at-home patients required care slightly longer than those in traditional settings, but the difference was negligible (less than a day).

Feedback collected from patients, caregivers and family members about at-home care was overwhelmingly positive. Patients reported feeling more relaxed, less anxious and less depressed at home, which seemed to facilitate their recovery. Caregivers and family members believed better health outcomes were one of the main benefits of receiving care in a familiar and comfortable environment.

“People who have been in a brick-and-mortar hospital and also cared for in their home report that they sleep better in their beds and that it is less noisy and confusing,” Nancy Foster, vice president for quality and patient safety at the American Hospital Association (AHA), recently told Home Health Care News. “For older folks who sometimes get confused when they’re away from home, this is a way for them not to experience those challenging effects of being hospitalized but still receive hospital-level care.”

Lessons learned

While the feedback received was primarily positive, it also revealed some limitations and opportunities.

One concern was the potential need for additional care, especially for patients with limited mobility. While approved hospitals are expected to provide all nursing care, including help with daily activities, CMS received feedback that, at times, family members took time off to be with their loved ones or hired extra nursing aides.

Another common concern was the program’s effective implementation. Specifically, there was potential for confusion among clinicians and hospital staff regarding the services provided and among patients about what services are covered by Medicare.

Overall, feedback from patients and caregivers aligned with existing evidence on HaH programs; they generally viewed the care provided as safe, effective and a positive experience.

“Clinicians, doctors and nurses who have been involved in the HaH program are enthusiastic about it,” Foster said. “It allows them to have a deeper relationship with their patients, to see more of what their home life is like, and to be able to advise them on how to recover well and then how to stay well from whatever condition brought them into the hospital, even if that hospital was their home.”

The waivers and flexibilities associated with the AHCAH initiative expire Dec. 31, and its future remains unclear.

“By the end of the year, Congress will need to act to extend the Medicare waiver,” Foster said. “We’ve heard considerations of a bill that would extend it for five years, but we don’t know whether that will be passed.”

Foster added that if the bill is not passed, no fee-for-service Medicare or Medicaid patient could be cared for at home.

“Congress is concerned that we can demonstrate high-quality care being delivered, that we are not putting a tremendous burden on family members or other loved ones in the home, and they have expressed concern about whether this would be equitable,” Foster said. “However, we see a dominance of people with more limited means benefiting enormously from the hospital-at-home program.”

The post CMS Report Shows Hospital-At-Home Care Increases Recovery, While Decreasing Costs And Readmissions appeared first on Home Health Care News.

Hospital at Home (HaH) is a sustainable, innovative and next-generation health care model. From the physician’s perspective, it offers person-centered medical care and keeps patients out of the hospital, away from possible complications and on to better outcomes. However, there are still plenty of challenges for providers to work through.

“People love to have inpatient or acute level care in the comfort of their own home,” Dr. Adam Groff, co-founder of Maribel Health, told Home Health Care News. “The data suggests that for populations studied in multiple areas, [HaH] is a safe service with high-quality care, low readmission rates, low escalation rates, low infection rates and, bottom line, patients love it.”

Maribel Health, based in Hanover, New Hampshire, designs, builds and operates advanced clinical care models in the home and community to expand health system capacity and improve patient access.

While it seems like a win for patients and caregivers, the model has seen growing pains.

“One challenge is clarifying the distinction between HaH care and other in-home health care services like home health or skilled nursing facility (SNF) care,” Heather O’Sullivan, president of Mass General Brigham Home Hospital, told HHCN. 

Based in Boston, Mass General Brigham Home Hospital provides comprehensive home-based care, including chronic, urgent and acute care, directly to patients in their homes.

The structure and implementation of HaH care vary depending on the hospital’s needs, capacity and patient population. Some organizations run the program out of the emergency department and admit eligible patients to their homes. In contrast, others rely on community paramedics or specialty clinics to refer patients to the program.

“While the use of paramedics in health care is not new, the pandemic accelerated the scaling of this workforce to support home-based acute care,” O’Sullivan said. “By incorporating paramedics into the HaH model, we address workforce shortages while enabling health care professionals to practice at the full scope of their licensure. This expansion not only meets the complex needs of our patients, but also ensures that we are using our workforce to its optimal potential.”

The HaH model was introduced at Johns Hopkins in 1995 and was used to manage and treat older patients who refused hospital stays or were at higher risk of hospital-acquired infections.

Early trials of the model found the total cost of at-home care was 32% less than traditional hospital care, the length of stay was one-third shorter and the incidence of complications was dramatically lower.

“HaH can reduce hospital overcrowding and provide care that aligns with patient preferences,” O’Sullivan said. “As health care systems increasingly focus on strategic sustainability amidst a rapidly evolving health care ecosystem, scaling HaH presents a unique opportunity to meet growing patient demand while improving clinical outcomes and satisfaction.”

Though the structure of these programs varies, many commonalities exist. They are well-suited for medium-acuity patients needing hospital-level care, but stable enough for safe monitoring from their homes. They are also suitable for patients with conditions requiring defined treatment protocols, such as pneumonia, congestive heart failure, chronic obstructive pulmonary disease (COPD) or diabetes.

“One of the greatest advantages of this model is that it allows clinicians to enter patient’s homes, offering insights into social and environmental factors that may impact health – insights often missed in a traditional hospital setting,” O’Sullivan said. “This holistic view enables more tailored care.”

The Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver during the pandemic, which created a payment system for HaH through Medicare. Now, the model is popular enough that providers are operating within that waiver – which has been extended to the end of 2024 – but also outside of it.

Launching a program

Novant Health New Hanover Regional Medical Center in Wilmington, North Carolina, began enrolling patients in its HaH program in March. The program is in its early stages and is growing.

“To date, the Novant Health New Hanover Regional Medical Center (NH NHRMC) program has cared for approximately 70 acute patients in their home,” Christy Spivey, senior director of nursing, told HHCN. “Patient experience has been overwhelmingly positive, reaching satisfaction scores of 100%.”

According to Spivey, there have been no unexpected returns to the hospital, and readmission rates are either within or better than those of similar hospitalized patients. Based on the number of patients served at home, NH NHRMC has saved almost 300 in-hospital physical bed days, creating the capacity to keep higher acuity patients in those beds.

“Our health care providers have found great satisfaction in meeting the patient’s needs creatively, allowing the patient to heal in their home environment,” Spivey said. “Often, they find that providing health education is better received by the patient when they are at home. They can also include family members in the plan of care and education, which supports the patients. And the ease of access to the patient via technology makes it easy to see patients from wherever the provider is located.”

Spivey went on to say that patients benefit for many of the same reasons.

“First, they can heal in the comfort of their home, with loved ones, and even pets,” she explained. “They can easily reach a [nurse] or physician by touching a button on a screen if they have a question. Specially trained community paramedics and a physical therapist come to their homes to administer care and therapies, where the approach is tailored to their unique needs.”

Core tenets of the Novant Health program support optimal nighttime sleep, medically ordered meals, and optimized mobility, all tailored to the patient’s unique needs. Pharmacists, case managers, and other care team members can also visit the patient virtually to teach and support the patient’s care plan.

According to Spivey, nationally reported outcomes consistently show patients in these programs have higher satisfaction and lower readmission rates than similar patients who receive care inside the hospital.

Overcoming challenges

To be eligible for the Acute Hospital Care at Home program, patients must meet clinical and social criteria established by CMS. The program has 78 approved diagnoses, including pneumonia, COPD and urinary tract infections.

On Sept. 18, the U.S. House Energy & Commerce Committee approved a bill extending necessary flexibilities to benefit telehealth and hospital-at-home providers.

The Telehealth Modernization Act of 2024 would grant two-year extensions to various telehealth flexibilities implemented during the COVID-19 pandemic. These include continued payment for virtually furnished care services, eliminating in-person or geographic requirements for telehealth providers and supporting audio-only telehealth. These flexibilities are set to expire at the end of this year.

The act would also extend the hospital-at-home waiver by an additional five years. Again, for now, the waiver program is expected to expire at year end.

While the HaH model offers numerous benefits, it also comes with challenges. Significant barriers and limitations exist, including payment reimbursement issues, physician and patient resistance, patient safety concerns and implementation hurdles.

“The single biggest challenge is the looming end of the CMS Hospital Care at Home waiver,” Dr. Stephen Dorner, chief clinical and innovation officer for Mass General Brigham Healthcare at Home, told HHCN. “We need congressional action to extend the waiver and maintain federal support for this incredible care delivery model.”

Regarding challenges to care delivery itself, Dorner said that all health care providers are working to overcome them.

“The first is culture change,” he said. “This is not how people are used to providing or receiving acute hospital-level care, and it takes a lot of time and effort to educate and facilitate buy-in. Then, once people understand the phenomenal quality benefits associated with HaH care and agree to undertake it, the logistical challenges of delivering that care take hold. Orchestrating the complexities of home-based acute care delivery – staff, supplies, patients, equipment, medications, food – can be daunting. Finally, there is a burgeoning market for solutions to these challenges that is waiting on certainty from federal regulators that the waiver will remain in place before activating.”

Most private payers do not cover hospital-level care in the home. Hospitals have had some success with Medicare Advantage (MA) plans and Veteran Affairs (VA), but health systems with insurance plans have a similar opportunity to cover HaH care.

“It’s important for providers to write and call their senators and representatives to let them know they want their support for the continuation of the Acute Hospital Care at Home Waiver,” Dorner said. “When you look at the traditional health care landscape, the growing demand for access, and the ever-longer wait times for care, it’s clear that the status quo is unsustainable. We need new solutions to deliver better care, and HaH is our greatest promise to realize a better future in care delivery.”

The benefits of HaH for patients

Nancy Foster, vice president for quality and patient safety at the American Hospital Association (AHA), told HHCN that she believes people would be surprised at the costs of HaH programs, and the overall benefits.

“We’ve looked at various studies,” she said. “They are comparable to the brick-and-mortar hospital, partly because we use staff time differently. We have staff traveling to the patient and so forth. We need technologies that you might not have to use in the hospital, but that assist with bi-directional communication. So, there are different costs, but the totals are similar.”

Dr. Ronald Paulus, co-founder of Maribel Health, agreed and provided more background.

“The literature is pretty clear that when your emergency department is congested, there’s significant harm that accrues to patients, including excess mortality,” Paulus told HHCN. “So, anything that improves the throughput of my emergency department and inpatient floors is a good thing from a safety perspective. But it is also good from an economic perspective. If you look at how HaH has been studied, it’s been shown to reduce direct costs by just under 40%. It’s at least 20 times more capital efficient, and when the program is run effectively, it can generate double digit EBIDTA margins.”

Standing up a HaH program requires logistical and technical work, which requires time, staff and budget. Some hospitals have partnered with companies that can provide the technology, manage logistics or provide care coordination to facilitate the implementation of a HaH program.

According to O’Sullivan, to support the growth of this model, organizations must continue to focus on expanding the health care workforce and address gaps in education.

“This includes initiatives like industry and academic partnerships to create new career opportunities for students and the innovative use of a broad professional team in the home hospital model,” she said. “We are working closely with educational institutions to address gaps in standardized curricula, ensuring that the future health care workforce is well-prepared to meet the new and undefined demands of this growing model.”

Before the pandemic, there was skepticism that the quality of care provided at home would be as good as in the hospital. This could be changing. As patients are reluctant to go to the hospital and telehealth capacity is growing, HaH care is becoming a more desirable option for providers and patients.

“Growth can be achieved by demonstrating the success of HaH models, advocating for legislative support and continuing to innovate in care delivery,” O’Sullivan said. “At Mass General Brigham, we’ve reached 70 beds in our Home Hospital program. Our pilot program has evolved into a core service, delivering high-quality, patient-centered care at home. Research has consistently shown that patients and caregivers prefer this model due to its proven outcomes and an overall positive experience for all involved.”

Spivey said that overcoming barriers and limitations is an ongoing internal and external process, and that growth depends on the customer’s voice.

“As more people hear about the program, they ask their physicians if they can be included, which will provide more momentum,” she said. “We provide internal education and presentations to physicians, nurses and other team members. Case managers have worked to integrate screening processes into daily patient rounds. Screening protocols for the team have been honed to support more rapid identification of patients, including optimizing the electronic medical record to create patient lists based on inclusion criteria. Also, including family in the initial discussion about the program is critical. If the patient or family is uncomfortable with care in the home, they can decline participation. For those who consent to participate, it is clear that if they become uncomfortable while receiving care in the home, the team will work with them to address the issue or bring the patient back to the hospital, if necessary.”

Dorner said the most significant opportunities for HaH are better patient care, job satisfaction and value.

“We know that the quality of HaH exceeds traditional brick-and-mortar hospital care for the patients who can safely receive care at home,” he said. “We also know that clinicians who join HaH, either as part of a diversified traditional clinical portfolio or as their full-time job, report increased job satisfaction. Some of these clinicians, who otherwise would have left health care at the end of the pandemic, have found the clinical care of HaH to provide more fulfilling, deeper connections to patients, which is why many of us joined health care in the first place. All in all, there’s better value associated with HaH care, and delivering greater value at a greater scale presents a spectacular opportunity for health care across the United States.”

According to O’Sullivan, there is immense potential for health care system transformation using the HaH model.

“HaH can reduce hospital overcrowding and provide care that aligns with patient preferences. As health care systems increasingly focus on strategic sustainability amidst a rapidly evolving health care ecosystem, scaling HaH presents a unique opportunity to meet growing patient demand while improving clinical outcomes and satisfaction,” she said.

Dorner added that there’s a clear upside to investing in the growth of this care delivery model, given the long-term regulatory and financial certainty that will increase patient awareness of the HaH model’s benefits, as well as the hospital’s willingness to break out of the mold and do something innovative.

“Increasingly, we will see improvements to equipment becoming more modular, portable and interconnected,” he said. “We’ll see software solutions to care orchestration to make moving equipment and services across a broader geography seamless. Eventually, this will be the primary method of caring for many conditions that require hospitalization today, and society will greatly benefit from it.”

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Chief among their concerns was the impact that the rule – if finalized in its current form – would have on patients’ ability to access care, especially at a time when providers are already facing staffing shortages and rising supply costs.

Many of the organizations leveraged data to illustrate the ways providers already struggle to meet the demand for care seen across the country.

Others detailed specific actions that it urged CMS to take in order to prevent dire circumstances for providers and patients alike.

Home Health Care News highlighted standout statements from six organizations’ comment letters to CMS.

***

CMS understands [home health agencies], like all health services providers, will reduce costs in reaction to payment reductions. Cost reductions often can include service reductions involving the admission of patients, the scope of services offered, and the extent of services provided. Correspondingly, the CMS budget neutrality methodology will trigger further payment rate reductions that will eventually destroy the value of the home health services benefit. CMS has the authority and the responsibility to prevent such an outcome under 42 USC 1395fff to determine the “time and manner” of applying any rate adjustments under PDGM. CMS has the full discretionary power to go forward with the 2024 rate setting without the proposed 5.653% rate cut.

— National Association for Home Care & Hospice

***

Access to home health is already diminished. If CMS cuts payments further as proposed for 2024, access will be decimated.

CMS already recognizes the clear connection between access to care and payment rate reduction. In a recent proposed rule advanced by the Biden Administration to improve access to Medicaid services, including access to home- and community-based services (HCBS), CMS discusses the need for analysis when states engage in ‘rate reductions or payment restructurings’ in order to avoid hindering access to care.

CMS emphasizes the need for state Medicaid agencies to conduct further analysis regarding the sufficiency of proposed payment rates after reduction or restructuring in order to avoid reducing access to care. Given the tenuous state of access to home health under current levels, CMS should proceed with caution in moving forward with further Medicare payment rate reductions, consistent with its proposed policy regarding Medicaid rate-setting.

— The Partnership for Quality Home Healthcare

***

We commend the Biden Administration, from the early days of the campaign, for taking a strong stand on ensuring quality in long-term care services and particularly for promoting services

in home and community settings. However, the articulation of this vision is impeded by the Administration’s proposed 2.2% cut to home health services in this proposed rule. If implemented, CMS will have cut home health payment permanently by nearly 10% in two years (-9.356%). As we detail below, these cuts are coming at times when our members’ costs and demand for services are rising and cannot be met. Continuing to implement these cuts will have a devastating effect on older adults who rely on these services.

Further, it runs counter to the Administration’s stated goals of promoting equity and the use of home- and community-based care. From our vantage point, the combined impact of the proposed payment changes and current workforce and inflationary pressures would lead to waves of closures and the inability of providers that remain to take on new referrals.

The impact of CMS’ proposals stands in stark contrast to the Administration’s stance on the importance of long-term care.

— LeadingAge

***

We urge the agency to adequately resource [home health] providers as they are a critical part of the care continuum. We are particularly concerned about the substantial size of the agency’s proposed budget neutrality adjustment, a cut of 5.653%, and again call on CMS to withdraw it.

Instead, we urge the agency to revise its methodology to more accurately account for changes in care delivery and payment dynamics due to the implementation of the PDGM. We also have concerns about the inadequacy of the proposed market basket update given the financial pressures facing [home health] agencies, including critical staffing shortages and rising supply costs. In addition, final data from CYs 2021 and 2022 indicate that the market basket forecasts underpaid [home health] agencies by a combined 5.1% for these years. This, combined with the difficult inflationary environment and the large budget neutrality adjustment proposed in this rule, risks putting [home health] agencies in serious financial peril. As such, we urge CMS to utilize its authority to provide a market basket adjustment to account for these extraordinary circumstances.

— American Hospital Association

***

In addition to the impact of the proposed rule on home health providers and, therefore, Medicare beneficiaries, it is important to note the downstream consequences for overall Medicare spending. While there is an increasing demand for home health — a 33% increase in referrals sent to home health — home health acceptance rates have decreased by 15% as [home health agencies] have been forced to turn beneficiaries away due to labor costs and staffing shortages. Additional reductions in reimbursement to home health providers will further exacerbate these pressures and result in fewer home health options, as demand for skilled healthcare in the home grows.

Fewer home health options translate into an increase in unnecessary hospitalizations and referrals to higher cost care settings. We already saw these trends prior to the COVID-19 pandemic when Medicare beneficiaries were often more likely to be referred to other post-acute care settings. In addition, hospital discharge planners are having difficulty finding home health providers for beneficiaries, which is leading to increases in average inpatient hospital lengths of stay. For patients discharged to home health, hospital average length of stay increased 11% from 2019 to 2022. Should the home health provider market constrict further, Medicare costs are at risk of increasing, an unintended consequence of the proposed rule.

— WellSky

***

As of July 2023, patient referral conversions — a measure of the number of patients that were referred to home health and subsequently admitted — have now plummeted to 55%. This means that 45% of all patients seeking home health are being turned away from service, which extrapolates to 6.2 million patients being turned away annually.

Access-to-care issues are extremely frustrating for these 6.2 million annual patients denied home health services, and they may ultimately experience worse health outcomes and overall spending in the Medicare program. Home health is a low-cost, high-value service option when compared to alternatives, such as longer acute stays or placement at skilled nursing facilities or other long-term care facilities. A portion of these 6.2 million patients turned away from care end up in those higher cost alternatives, where, in addition to increasing Medicare spending, they also occupy beds and utilize clinical resources that are in short supply.

The decade-long trend around access to home health care is also very alarming. A decade ago, referral conversions, patients accepted into service after being referred to home health, stood at 79%. This number declined to 69% in 2019, which was the last full year before PDGM, and before the public health emergency started due to the COVID pandemic. Since the start of

2020, referral conversions have fallen from 69% to 55%, a staggering drop in less than four years. The timing of this access to care trend correlates with the CMS payment rate adjustments. The cause of this correlation is a shortage of home health clinicians, creating a situation where home health agencies simply do not have the clinical capacity to admit millions of patients needing home health services. A significant factor in this deficit of home health clinicians is the Medicare annual payment updates that have not kept up with inflation.

— Homecare Homebase

***

It behooves CMS to provide financial predictability to this sector in order for it to
accept an increased number of patient referrals from high-cost institutions, and
deliver patient-preferred, low-cost, high-quality care in the home.

As a technology company that processes millions of claims, Axxess has witnessed
the home health claims payer mix shift from traditional Medicare to Medicare Advantage (MA). While Medicare margins have historically been favorable for home health, the increase in Medicare Advantage cases to more than 50% has quickly reduced overall home health agency margins due to inadequate MA
reimbursement. [Home health agencies] must subsidize their MA case losses with traditional Medicare margins to remain financially viable, accept referrals and support CMS’ desire to shift more healthcare into the home setting.

Ongoing reimbursement cuts to Medicare [home health agencies] to drive down Medicare margins is shortsighted. [Home health agencies] have no leverage with MA and Medicaid to negotiate better payment rates. CMS must consider the overall [home health agency] payer mix when proposing payment adjustments, particularly inadequate reimbursement by MA and Medicaid. In 2023, [home health agencies] are experiencing a greater percentage of cases with zero or negative margins. The proposed Medicare cuts to address profit margins solely under Medicare without a more wholistic view of the payer landscape that CMS oversees, will topple the provider community. Further, limited financial resources reduce the ability for [home health agencies] to invest in measures that achieve success in CMS’ Home Health Value-Based Purchasing (HHVBP) model.

— Axxess

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On Thursday, House Majority Leader Steny Hoyer (D-Md.) announced new legislation — H.R. 1868 — aimed at stopping automatic spending cuts to Medicare and other programs. House lawmakers plan to consider the legislation this week, setting the stage for possible relief before a 2% Medicare cut kicks back in next month.

Home health providers, hospitals and other Medicare-reimbursed health care organizations had hoped to see a continued sequestration pause in the $1.9 trillion “American Rescue plan,” signed into law by President Joe Biden on Friday.

That ultimately didn’t happen, however.

“The [American Hospital Association] is disappointed that the bill does not deliver more overall funding for the Provider Relief Fund, which has been crucial in supplying hospitals, health systems and other providers with resources during the pandemic,” Rick Pollack, the trade group’s president and CEO, said in a statement. “We are also concerned that this bill does not include an extension of relief from Medicare sequester cuts, which will go back into effect at the beginning of next month, and also fails to provide loan forgiveness for Medicare accelerated payments for hospitals.”

The automatic 2% cut to all Medicare providers was paused through 2020 as a result of the Coronavirus Aid, Relief and Economic Security (CARES) Act. Subsequent legislation then extended that temporary moratorium through March 2021.

The National Association for Home Care & Hospice (NAHC) is among several other health care groups calling for continued relief from sequestration.

“This is the wrong time to give everybody a 2% cut,” NAHC President William A. Dombi said at the Home Health Care News PDGM Summit earlier this month. “We hope [lawmakers are] going to listen. They’ve listened before. But we thought we might get a longer extension in December, and we only got an extension until the end of March.”

Instead of lasting through March, the American Hospital Association has called for an extension through the rest of 2021.

So far, the pause to Medicare sequestration has come with ample bipartisan support.

“The House will consider legislation to ensure that we preclude cuts to Medicare, as well as farm supports and other programs implicated by sequestration,” Majority Leader Hoyer said after announcing his legislation.

In addition to extending the pause on the 2% Medicare cuts, H.R. 1868 would also waive statutory pay-as-you-go (PAYGO) budget enforcement measures triggered by the deficits in the American Rescue Plan.

Broadly, PAYGO is a rule requiring that new legislation not increase the federal budget deficit or reduce the surplus. If legislation subject to PAYGO increases the deficit through an increase in federal spending or a reduction in revenues, that increase must be offset by increased revenue or reduced spending in other areas.

Without Congressional action, Medicare spending would be reduced by 4% in 2022 to balance the added spending from the $1.9 trillion American Rescue Plan, with $345 billion to be sequestered from remaining mandatory spending accounts.

The PAYGO cuts to Medicare are capped at 4%. Medicaid spending is exempt from pay-as-you-go reductions, as is Social Security, federal retirement programs, veterans’ programs and other low-income entitlement programs.

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The “sequestration holiday” was immediately seen as a common-sense lifeline for cash-strapped home health providers on the front lines of the COVID-19 pandemic, many of whom had to figure out how to pay for expensive personal protective equipment (PPE) for the very first time.

Originally, the pause on Medicare sequestration was supposed to conclude at the end of 2020. A subsequent coronavirus relief package, however, extended the holiday through March of this year — which is coming up fast.

“Medicare has been burdened with a 2% sequestration annually since 2013,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), said during a fireside chat at the Home Health Care News PDGM Summit on Wednesday. “The sequestration has been put in a pause at this point. It has been since last March. But that pause will run out at the end of this month of March.”

The Washington, D.C.-based NAHC is currently in the process of asking lawmakers to again extend the sequestration pause. It sent a letter to Congress along with five other health care advocacy groups on Tuesday.

Those groups included the American Health Care Association (AHCA), the American Medical Association (AMA), the American Hospital Association (AHA) and the Association for Clinical Oncology (ASCO). The National Hospice and Palliative Care Organization (NHPCO) likewise signed onto the letter.

“This is the wrong time to give everybody a 2% cut,” Dombi said. “We hope they’re going to listen. They’ve listened before. But we thought we might get a longer extension in December, and we only got an extension until the end of March.”

If another extension isn’t an option, the letter also floats the idea of additional funding to counteract the 2% cut.

“Our providers are working tirelessly to deliver the best care for patients, families and communities, and we urge you to include in legislation addressing the COVID-19 pandemic additional funding to counter sequester cuts to Medicare providers,” it reads. “This funding would allow for continued support of providers’ COVID-19-related lost revenues, as well as additional expenses due to activities such as purchasing supplies and equipment, standing up emergency testing centers and the construction and retrofitting of facilities.”

In a perfect world, Congress would consider getting rid of the 2% sequestration cut entirely. But with the Medicare Trust Fund nearing bankruptcy, that’s not entirely realistic, NAHC’s leader suggested at HHCN’s PDGM Summit.

As of Wednesday, it’s too difficult to firmly say what will happen with the cut.

“We have efforts underway to get Congress to extend it,” Dombi said. “I wish I could even say I’m cautiously optimistic about it. But I can’t even say we’re cautiously optimistic.”

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Health insurance giant Humana Inc. (NYSE: HUM) has filled two leadership roles with internal candidates.

The Louisville, Kentucky-based company has promoted Joseph Ventura to General Counsel and named Douglas Stoss interim lead for Humana’s Office of Corporate Affairs. Both will serve as members of the company’s management team.

Ventura replaces Christopher Todoroff, who is retiring after 10 years as general counsel and chief legal officer at Humana. Ventura joined Humana as legal council in 2009. Todoroff and Ventura will work together for the next few months to ensure a smooth transition.

Meanwhile, Stoss, who has been with the company since 2014, will lead corporate affairs until Humana hires someone to replace Chief Corporate Affairs Officer Heidi Margulis, who will remain on the Humana Foundation Board of Directors. Margulis’s departure comes after 33 years with Humana.

Before Stoss stepped into the new role, he led the company’s Washington, D.C. office. There, he helped the company navigate the federal legislative and regulatory landscape.

Humana also recently announced that Chief Medical Officer Roy Beveridge will be stepping down this spring. He will be succeeded by Dr. William Shrank, who most recently served as CMO of the insurance services division at the University of Pittsburgh Medical Center.

LHC adds hospital CEO to board

Home health, hospice and personal care powerhouse LHC Group, Inc. (Nasdaq: LHCG) is shaking up its board of directors.

Teri Fontenot will join the board of the Lafayette, Louisiana-based company March 1. She succeeds Tyree Wilburn, who will be moving to LHC’s Transitional Advisory Council.

Fontenot is currently the CEO and president at Baton Rouge-based Woman’s Hospital, the largest birthing and neonatal intensive care health system in Louisiana. She has held various positions there over the past 27 years.

Additionally, she currently holds memberships on the board at Louisiana-based insurer Amerisafe, the American College of Healthcare Executives Board of Governors and the American Hospital Association’s Center for Health Innovation Advisory Board.

“Teri’s healthcare board and community leadership experience with local, state and national organizations is extensive and will be an invaluable resource to LHC Group’s shareholders, employees and joint venture partners,” Keith G. Myers, LHC Group’s Chairman and CEO, said in a release announcing the news. “Teri is highly respected as a leader and advocate for the healthcare industry and has a passion for corporate governance that has extended to her service on two public company boards.”

National HME taps 7-Eleven executive

National HME, Inc., a company that supplies medical equipment for hospice providers, has tapped an executive from a convenience chain powerhouse to be its new CEO.

Ena Williams comes to the position after a decade at 7-Eleven, where she most recently served as senior vice president and leader of the company’s international division, worth about $25 billion. Previously, she also worked at ExxonMobil Corporation.

National HME board chose Williams in hopes she can leverage her experience managing complex logistical operations to help the Irving, Texas-based company thrive as the hospice industry booms.

“She has a track record of transforming complex businesses through a focus on customer service, efficient operations and people leadership that we believe is transferable to the hospice market and National HME,” board member Lew Klessel said in a release announcing the news.

Williams stepped into the role Jan. 7.

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The Medicare appeals backlog grew exponentially in recent years due, in part, to more aggressive Medicare integrity efforts and an aging U.S. population. Of the 658,000 claims in the appeals backlog, some are home health claims.

The American Hospital Association’s (AHA’s) four-year plan to clear the backlog is a “thoughtful and reasonable” approach to a “complex problem,” U.S. District Judge James Boasberg writes in a Memorandum Opinion dated Dec. 5, 2016.

HHS has previously called the timetable, which necessitates the huge Medicare appeals backlog be cleared by 2021, “impossible,” adding that the project requires additional funding from Congress and would force the agency to violate Medicare law by paying claims that lack merit.

Though HHS Secretary Sylvia Burwell claims that “she is hard at work, progress is in sight” with respect to clearing the Medicare backlog, her “latest brief does not provide enough evidence of progress to tilt the scales,” Boasberg writes.

So, as it stands, however, HHS must achieve a 30% reduction of backlog cases by December 31, 2017; a 60% reduction in backlog by December 31, 2018; a 90% reduction in backlog by December 31, 2019 and clear all of the backlog by December 31, 2020.

“Satisfying the statutory demands for both accuracy and timeliness will no doubt prove challenging, but such is the task at hand,” Boasberg writes.

The Court did decide, however, that it will not automatically enter default judgments in all qualifying appeals on Jan. 1, 2021, as doing so could potentially endanger the Medicare Trust Funds.

Now, if Burwell fails to meet the aforementioned end-of-year deadlines, the plaintiffs may move for default judgment or to otherwise enforce the writ of mandamus, the Court decided.

Written by Mary Kate Nelson

The post HHS Appeal to Slow Backlog Mandate Doesn’t ‘Tilt the Scales’ appeared first on Home Health Care News.

In conjunction with the recently-released payment proposal to lower home health payments by $180 million in 2017, the Medicare Payment Advisory Commission (MedPAC) proposed an overhaul of the current payment system for post-acute care settings, which would affect how much providers are paid each year from the Centers for Medicare & Medicaid Centers (CMS).

Much of the proposed new system aims to meet goals outlined in the IMPACT Act of 2014, including reducing health care costs, improving care management and shifting toward value-based purchasing. At the same time, MedPAC has recommended deeper cuts for home health reimbursements, citing that Medicare has overpaid for home health care since the prospective payment system was created in 2000.

Home health care groups have made their voices known that many of the proposed changes could have numerous negative impacts on home health beneficiaries and agencies.

The Case for No Cuts

The American Hospital Association (AHA), a group that includes approximately 1,100 hospital-based home health agencies, offered comments against some of the proposed changes that could take place in the next few years, including the outlier payment changes, which would require home health agencies to report services in 15-minutes units, rather than the total cost per visit.

AHA is concerned this change would give “equal weight to each 15-minute increment of care,” the group wrote in its comments. This could result in shorter visits receiving substantially less payment and leave out other costs associated to the care, including travel time.

“As such, we encourage CMS to refine the proposed policy to give greater weight to the initial 15-minute units to ensure such fixed costs are accurately reimbursed,” the AHA wrote.

The group also urged CMS to consider full reimbursement for partial 15-minute units to avoid a “reporting cliff,” where agencies would be incentivized to not provide care outside of 15-minute reporting intervals.

The AHA also expressed concern over performance-related Medicare cuts within the home health value-based purchasing demonstration, which places up to 8% of a home health agency’s payment at risk.

“The AHA believes placing up to 8% of home health agency payment at risk for performance is too much, too fast, especially in light of the significant Medicare payment reductions home health agencies have endured in recent years,” the AHA wrote.

The group is not the only one within the industry to believe the payment risks are too high, within the value-based purchasing demonstration and in other proposed changes.

The Alliance for Home Health Quality and Innovation, a membership-based non-profit organization comprised of not-for-profit and proprietary home health care providers, also recently commented on the proposed payment cuts for 2017, which they say threaten some of the most vulnerable Medicare patients, who may also tend to be minority populations.

“The rebasing and case mix adjustments that will result in home health payment rate reductions jeopardize access to quality care for patients who are in greatest need of protection,” The Alliance wrote in its comments. “Moreover, the rate reductions threaten the ability of home health providers to make necessary investments to provide better care for patients and the entire health care system.”

The group recommended that CMS rethink the impact that cuts could have on its home health population.

New Program Burdens

The Alliance also took aim with CMS’ recent pre-claim demonstration, which began in Illinois earlier this month. The group wrote that the new reimbursement model creates significant administrative burdens and hinders access to home health care, when care should be expanded instead.

“The pre-claim review demonstration, which CMS announced in June of this year, compounds the already complex process of delivering home health care and severely threatens patient access to care in the identified states (Illinois, Florida, Texas, Michigan, and Massachusetts),” The Alliance wrote. “The pre-claim review demonstration is a major concern for a growing population of Medicare beneficiaries who rely on home health care to provide high-quality care in their preferred home setting.”

Numerous industry groups stood up against the pre-claim demonstration, urging CMS to drop the measure over numerous concerns related to physician requirements and more.

The open comment period for home health agencies to submit comments on the prospective payment system changes closed on August 26. CMS has not yet released a final rule on home health reimbursement changes.

Written by Amy Baxter

The post Industry Groups Critique Home Health Reimbursement Changes appeared first on Home Health Care News.

The comments were largely against the rule, which CMS has touted as a means to reduce fraudulent and abusive practices. The new model would require agencies to hold off care until they receive authorization, instead of verification after claims are made. Home health agencies maintain that the rule would slow down care to patients who need it and result in heavy administrative burdens on the industry and CMS.

The pilot proposal was quietly announced by CMS in the Federal Register in early February. In its current form, the proposed rule would pilot in Florida, Texas, Illinois, Michigan and Massachusetts.

A Sweeping Slowdown

The rule, if enacted, could require home health agencies to wait on authorization when home health patients require changes to their care plans. The result could potentially slow down care for patients in need and leave home health agencies at risk.

“It’s going to be harmful for a significant portion of patients that have issues that arise unexpectedly,” John Reisinger, a home health care consultant, CPA and principal of Innovative Financial Solutions, told Home Health Care News. “There are going to be situations that occur during the treatment in the home in which a change has to be made to the original plan of care. If that’s the case, we’re going to have to get that approved before providing other care. It’s absolutely ridiculous.”

Multiple industry groups, including the The American Hospital Association, commented on the proposal in the days before the open comment period ended. A common theme among the comments from groups: The sweeping regulation the proposal would enact across the five states named in the pilot is too broad to actually achieve its goals.

“We urge CMS to focus on interventions that target [home health] agencies with likely fraudulent practices, based on analysis of Medicare claims,” AHA Executive Vice President Tom Nickels wrote. “Such an approach would be more effective than using an across-the-border prior authorization, which would burden the entire home health field in these states, as well as already-overloaded Medicare contractors. CMS also must include comprehensive protections for beneficiaries who would likely be affected by this policy, such as provisions to ensure timely prior authorization coverage decisions and beneficiary appeals—details of which are absent form this proposal.”

As CMS continues to push for policies that ultimately aim at cracking down on Medicare fraudulent practices and reduce overall health care costs, some advocates for the industry say the policies are poorly directed against home health instead of other pain points along the care continuum.

“The referral source is supposed to be the front line in insuring that what is being done in home care is proper and necessary,” Reisinger said. “All CMS is doing is creating a duplicative step that costs the program money and delays care.”

Participating in Policy Making

With so much seemingly at stake for home health industry, the comment period offered an opportunity for agencies, employees and others within home health to voice their opinions about the proposal and inform CMS about the potential administrative burdens and patient care concerns.

Reisinger recently urged home health agencies to comment on the proposal in an effort to deter what could be a “detrimental” new rule for the industry. While roughly 250 comments flowed in on this proposal, Reisinger says higher participation rates could make a bigger impact in the rule-making process with CMS.

“The comments make a big difference,” Reisinger said. “We see changes to proposed rules based on comments that are submitted. Any participating party in home health can comment. …People complain about what CMS is doing, but they don’t take the time and the effort to comment. It’s one of the areas where this industry has always fallen woefully short.”

Some of the comments from the industry take issue with other requirements home health agencies currently have to follow, including giving care to a patient within 48 hours of a referral. Waiting for prior authorization could slow down this process overall, delaying care at the OASIS stage and adding administrative burdens for CMS and agencies alike.

“Going to a prior authorization process is going to cause a rewrite of the conditions of participation,” Reisinger said.

Following the closure of the comment period, CMS will review the submitted comments from members of the industry and likely release a finalized pilot. Reisinger hopes to see the rule scrapped entirely.

Written by Amy Baxter

The post Home Health Lashes Back Against Preauthorization Proposal appeared first on Home Health Care News.

About eight out of 10 Americans support Medicare and private insurance coverage for advance care discussions, and nine out of 10 doctors say these talks should be conducted with patients, according to a study by the Kaiser Family Foundation.

The discussions allow patients and doctors to determine the type of care a person wants to receive toward the end of life. While it’s a topic that can make some feel uncomfortable—about half said they would feel comfortable talking with a doctor about this subject—there are many important decisions during the final stages of life for which a person’s preferences can be taken into account. For example, some people may choose to receive home care during their final weeks or make other advanced plans related to how care is delivered to them if they become unable to make decisions due to a chronic illness.

While most agree talking about end-of-life care is important, only 17% of respondents in the survey said they’ve discussed this type of care with a doctor or another health care provider, including 27% of seniors 65 and older, the study found.

CMS released its proposed changes in early July to the Medicare Physician Fee Schedule for 2016 that would allow practitioners to bill for end-of-life care discussions with Medicare beneficiaries. Experts have agreed for some time that end-of-life care has fallen short in terms of how it is coordinated and delivered.

“For Medicare beneficiaries who choose to pursue it, advance care planning is a service that includes early conversations between patients and their practitioners, both before an illness progresses and during the course of treatment, to decide on the type of care that is right for them,” the CMS proposal reads.

Involving patients in the process earlier—and allowing doctors to bill for these talks—could lead to improved patient care, studies have shown.

The American Hospital Association (AHA) and the American Medical Association (AMA) have voiced support for the measure.

“This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional,” the AMA wrote in a statement. “This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions.”

End-of-life decisions are not weighted by the cost of care in the CMS proposal, but this type of care does play a significant role in health care spending. End-of-life care is one of the priciest expenditures for Medicare and makes up about one-third of spending, according to the Dartmouth Atlas of Health Care.

There has been some opposition to the proposal, despite public majority support for these discussions to be a part of the health care billing system. Sarah Palin, former Governor of Alaska and one-time GOP vice presidential candidate, took to social media to compare end-of-life plans to “death panels,” resurrecting an inference that such talks would lead to panels that decide who would receive care.

GOP opposition could indicate that the decision, as part of health care changes brought on by the Affordable Care Act, will be an issue in the upcoming presidential election.

CMS will issue a final rule on the plan by Nov. 1. The discussions would be voluntary, and doctors could start receiving payments beginning Jan. 1.

The decision over these talks comes at the same time as a debate over palliative care in states such as California, where legislators are considering a bill that would allow patients in the advanced stages of a terminal illness to choose to end their lives.

Written by Amy Baxter

The post Public Rallies Behind Medicare Payment for End-of-Life Talks appeared first on Home Health Care News.