“Since Hospital at Home was implemented just a few years ago, we have seen this program deliver positive patient outcomes and reduce costs nationwide,” Carper said in a press statement.

Currently, the hospital-at-home waiver program is set to end on Dec. 31.

In 2020, CMS rolled out the Acute Hospital Care At Home program. The CMS waiver program was a response to the COVID-19 pandemic, and allowed providers to receive reimbursement for delivering hospital-level care in the home at a time when hospitals were struggling with capacity.

By creating a reimbursement mechanism, the waiver effectively addressed one of the biggest challenges to implementing hospital-at-home programs at-scale across the country.

As of May, 330 hospitals, across 136 systems, in 37 states have been approved to take part in the waiver program.

“The Acute Hospital Care at Home program has revolutionized health care for so many Americans by improving care while cutting down on the health risks associated with hospital stays,” Scott said in a press statement. “I’m proud of our efforts to extend this program, ease pressure on our health care system, and allow thousands of vulnerable Americans to continue receiving high quality care from the safety of their homes.”

This isn’t the first time that extending the waiver program has been on the table.

In 2022, the “Hospital Inpatient Services Modernization Act” was introduced. The legislation was, again, sponsored by Sens. Tom Carper (D-Del.) and Tim Scott (R-S.C.). Reps. Brad Wenstrup (R-Ohio) and Earl Blumenauer (D-Ore.) also sponsored this bill, which extended the waiver two more years.

What’s more, Sens. Marco Rubio (R-Fla.) and Tom Carper (D – Del.) also introduced the At Home Observation and Medical Evaluation (HOME) Services Act last month. The bill would expand the scope of hospital-at-home providers by allowing them to care for “observation status patients.”

“Addressing our health care challenges requires innovative solutions,” Rubio said in a press statement. “The HOME Services Act builds on the success of the hospital-at-home program to lower costs and burdens and improve patient outcomes and satisfaction.”

Aside from legislative action from policymakers, providers and other industry stakeholders have been vocal in their efforts to extend the waiver.

In March, a large group of hospital-at-home stakeholders penned a letter addressed to Senate majority leader and Senate minority leader – Sens. Chuck Schumer (D–N.Y.) and Mitch McConnell (R–Ky.).

The letter called for at least a 5-year extension of the waiver program before its expiration at the end of 2024.

“The waiver must be extended to enable hospitals and health systems nationwide to continue building out the logistics, supply chain, and workforce for hospital-at-home (HaH) and to encourage multiple payers outside the Medicare program, including Medicaid programs, to enter the HaH market,” the cohort wrote in the letter. “An extension will also allow home-based services to be developed equitably across populations everywhere and ensure hospital inpatient unit care is available for the patients who need it while enabling patients who can and want to be treated in their home to have the opportunity to do so, creating needed capacity for hospitals without increasing health system costs.”

The letter includes signatures from companies like ChristianaCare, CommonSpirit Health, Right at Home and Best Buy Health. Advocacy group Moving Health Home was also among those that signed the letter.

The post US Senators Move To Extend CMS’ Acute Hospital Care at Home Waiver With Bill Introduction appeared first on Home Health Care News.

The waiver – which is largely responsible for hospital at home’s considerable growth over the last three or so years – is set to expire on Dec. 31.

In a letter to the Senate majority leader and Senate minority leader – Sens. Chuck Schumer (D–N.Y.) and Mitch McConnell (R–Ky.), respectively – dozens of providers asked for “at least a five-year extension” to the waiver program.

“The undersigned stakeholders, representing hospital-at-home (HaH) programs, physicians, physician assistants, pharmacists, nurses, emergency medical technicians, paramedics, patient advocacy organizations, hospitals, health systems, and care model enablers, are writing to ask for at least a 5-year extension of the Acute Hospital Care at Home waiver program (AHCaH) before its expiration at the end of 2024,” they wrote. “Without an extension, Medicare beneficiaries will lose access to HaH programs that have been demonstrated to provide excellent clinical outcomes and lower the costs of care.”

As of Feb. 14, 313 hospitals and 131 health systems across 37 states were participating in the waiver program.

Since the Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver in late 2020, patients have experienced positive outcomes.

Specifically, from November 2021 to March 2023, only 7.2% of patients treated in the home were transferred to the hospital, according to a study published in JAMA. Only 39 unexpected deaths were reported – just 0.34% of patients. Most of those deaths were due to a progression in COVID-19 symptoms.

Health systems have invested heavily in the model, both in and outside of the waiver program. Medicare Advantage plans, too, have begun to fund hospital-at-home care.

Last month, Sens. Marco Rubio (R-Fla.) and Tom Carper (D – Del.) also introduced the At Home Observation and Medical Evaluation (HOME) Services Act. That would allow hospital-at-home providers to care for “observation status patients,” and not just acute patients. Observation status patients are generally ones waiting to hear from a health system whether they will be admitted to the hospital or not.

Obviously, the HOME Services Act would be contingent on an Acute Hospital Care at Home extension.

The chief architect of Medically Home’s hospital-at-home program, Dr. Pippa Shulman, recently told Home Health Care News that the care model is reaching a “tipping point” in the U.S.

Providers are invested in the model. Patients are aware of the model, and prefer it to brick-and-mortar care.

But there still remains some financial uncertainty moving forward.

“Not a week goes by now where we don’t hear a story of a patient or a family member asking for hospital at home,” Shulman, the chief medical officer at Medically Home, said. “The word is out, and that gets me really excited. But the health care system more broadly needs to catch up with where patients and families are at. That tipping point is coming.”

The model has bipartisan support, too. Stakeholders just need lawmaker action to follow.

“To achieve this future, the waiver must be extended to enable hospitals and health systems nationwide to continue building out the logistics, supply chain, and workforce for Hospital-at-Home (HaH) and to encourage multiple payers outside the Medicare program, including Medicaid programs, to enter the HaH market,” the letter read. “An extension will also allow home-based services to be developed equitably across populations everywhere and ensure hospital inpatient unit care is available for the patients who need it while enabling patients who can and want to be treated in their home to have the opportunity to do so, creating needed capacity for hospitals without increasing health system costs.”

Best Buy Health, GE HealthCare (Nasdaq: GEHC), Kaiser Permanente, DispatchHealth, Moving Health Home, Biofourmis, Right at Home, Inbound Health and Henry Ford Health are among the many companies that signed the letter.

The post Hospital-At-Home Stakeholders Push For Acute Hospital Care at Home Waiver Extension appeared first on Home Health Care News.

In anticipation, home health providers and advocates have been appealing to Congress, educating, calling to action on social media and more.

All of these efforts are the final push from an industry that has been very vocal about its opposition to the proposed rule, which was released in June.

Home Health Care News recently caught up with many of those providers and advocates to learn more about what they’ve been doing to push for a more favorable final rule.

At this point we are focused on a combination of the White House and Congress, pushing for a pause of the proposed rate cut in 2024. Congressional allies are working on our behalf in that respect. We are also hedging our bets by setting up for a congressional effort to stop the cut during the budget process. We need all hands on deck, particularly with home health agency staff contacting their local congressional delegation.

— William A. Dombi, president of the National Association for Home Care & Hospice

***

With the final rule quickly approaching, Bayada Home Health Care has been all hands on deck, diligently mobilizing our employees and advocates to make sure congressional members hear our voices. In conjunction with PQHH and NAHC’s industry-wide efforts, advocates have called and emailed federal lawmakers and published op-eds to urge lawmakers to support the Preserving Access to Home Health Act. Additionally, Hearts for Home Care – Bayada’s 501 (c)4 advocacy arm – has been active online and in-person, posting on social media and traveling to Washington, D.C., to further enforce our message that congressional action is needed to stop CMS’ proposed Medicare cuts. From our positive conversations with members, we are hopeful that our efforts have been recognized and have helped to move the needle forward on behalf of the entire home health care community.

— David J. Totaro, chief government affairs officer at Bayada Home Health Care

***

Last year’s home health payment reduction forced many providers to make difficult decisions, from reducing service area to letting go of staff, in order to keep their organizations afloat. Should this year’s proposed 2.2% cut to home health payment be finalized, providers will need to brace for the same impact in 2024. We urge CMS to postpone cuts for this year while we continue work on avenues for permanent relief.

For instance, we see opportunities in ensuring that the Home Health Value-Based Purchasing (HHVBP) Model focuses on the right measures of care. We have also seen an interest from Congress in holding Medicare Advantage plans accountable, which is increasingly important both for providers and the system as a whole as more home health episodes occur in Medicare Advantage. Plans must cover the true cost of service.

We’re already working with members of Congress to begin rethinking how the home health benefit should work. We know it’s on their minds too, as evidenced by the Senate Finance Committee hearing last month and the introduction of the Preserving Access to Home Health Act of 2023, which we support. There’s incredible support for these services, but CMS says its hands are tied on the payment methodology. Change is needed to best support beneficiaries who need these services the most, specifically those in rural and underserved areas. We believe that developing payments to support providers serving these communities will be invaluable. We are also looking into how to better track actual access to home health services. MedPAC’s current definition of access is failing millions of Americans. It’s time to rethink what true access means in terms of choice, in terms of services, and in terms of location.

— Mollie Gurian, vice president of home-based and HCBS policy at LeadingAge

***

In anticipation of the final rule, the Partnership and our members are using every tool in our toolbox to influence the outcome of the HHPPS for 2024. We are meeting with – and reaching out to – administration officials at the White House, HHS, CMS, and OMB. We are coordinating with our champions in Congress to put pressure on the Biden Administration. We have broadly activated our grassroots army to ask Congress to use its muscle in stopping the proposed cuts. We’re working with NAHC this week to beef up the conversation on social media among our advocates and working with our state association partners to elevate the issue on the local level. It’s critical that all home health stakeholders use their voice right now to speak out about how these cuts will harm patient care.

Once the rule is finalized, the Partnership will be evaluating its impact on access to care for the Medicare population and how it impacts ensuring that providers can meet the high demand for home health services which has been diminishing under the weight of the cuts. I encourage all of us to carefully analyze the final rule to determine whether CMS has taken any action to eliminate or significantly mitigate the deep cuts that have been proposed. Home health has already been cut by billions since 2020 and the market basket has been woefully inadequate to cover the costs of inflation. We, and the entire provider community of caregivers, are ready to intensify our efforts to seek a permanent legislative solution to stabilize home health and protect access to care for the most vulnerable of the Medicare population. The future of the home health program depends on these efforts.

— Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare

***

We are engaged in a multi-faceted approach to minimize an unfavorable home health final payment rule. We are leveraging our extensive network and resources to layer advocacy action from grassroots to grasstops, engaging not only our 1,000 employees, but also leading on education and technology tools for the industry. By equipping providers with the necessary knowledge and tools, we are helping them prepare for every outcome.

In addition, Axxess is committed to the industry’s viability and the accessibility of home-based care for everyone. We are leveraging our political action committee, the Axxess PAC, to support the united voice and work of our national associations, ensuring that our advocacy efforts are amplified and impactful.

For providers preparing for the possibility of an unfavorable final rule, we recommend staying informed and engaged. By joining forces with industry associations and leveraging resources like the Axxess PAC, providers can collectively work toward influencing positive change and protecting the interests of the home health community.

— Deborah Hoyt, senior vice president of public policy at Axxess

***

Between now and the issuance of the final rule, Enhabit Home Health & Hospice (NYSE: EHAB) is focused on bringing as much attention as possible to what we know is true: patient access to home health care is being impacted by Medicare’s continued cuts.

In August, our public comment letter and those of many others highlighted to CMS what the impact will mean for patients and providers; then in September, home health experts testified to Congress about the same; and here in October, we are working to focus the attention of the Biden Administration on what will happen if CMS moves forward with its proposal to further cut the Medicare home health benefit. Our elected officials need to be aware of the impacts of the CMS proposal given the priorities around health equity, increasing access to high-quality care and avoiding cuts to Medicare. And importantly, administration officials should know that CMS has the discretion under existing authority to move away from the agency’s proposal.

On top of these efforts, there are also many incredible people from all over the country – many of whom work in home health and understand the importance of this moment – that are taking the time to call Capitol Hill, write a letter to a member of Congress, or even author an op-ed in a local paper, all in a community-wide effort to let our government know that these proposed cuts should not be finalized.

In terms of preparation for the final rule, our local leaders remain focused on managing their resources to continue to deliver our high quality of care in the most efficient manner.

— Andrew Baird, vice president of government affairs & policy counsel at Enhabit Inc.

***

Home health is the foundation of home-based care. The long-standing benefit has opened the door to broader thinking about what’s possible at home. Innovation like hospital-at-home, SNF at home, or home-based services like home dialysis or home infusion would not be possible without the underpinning home health provides.

As we look to a future where seniors are aging in place and higher acuity services are offered at home, we cannot allow this foundation to erode. While the reimbursement structures differ, new care models rely on the precedent and groundwork set by the home health benefit. As providers look toward the possibility of an unfavorable rule, it’s important to share data, patient stories and paint the picture of the detrimental effects of further cuts to this valuable benefit.

— Krista Drobac, founder of Moving Health Home

The post The Last-Ditch Efforts Home Health Providers, Advocates Are Making To Nix Payment Cuts appeared first on Home Health Care News.

When it comes to legislation aimed at expanding at-home care initiatives, most have learned to temper expectations from the jump.

That’s part of the reason why the new, sweeping Expanding Care in the Home Act (ECHA) casts such a wide net.

When the Washington D.C.-based advocacy group Moving Health Home was formed, two of the main policy-specific changes that it targeted were hospital at home and SNF at home. Those types of programs are generally understood by legislators and the general public at this point.

“The problem that we realized quickly is there are so many services that actually surround a patient’s hospital-at-home or SNF-at-home situation that we really needed more policies to change in order to truly offer seniors the ability to stay home,” Moving Health Home Founder Krista Drobac told Home Health Care News. “So we said, ‘OK, let’s just do a catch-all bill.’”

The ECHA would create a personal care services benefit in Medicare. That would allow traditional Medicare beneficiaries – who don’t also qualify for Medicaid – the ability to receive home care services without having to pay out of pocket.

It would also increase the accessibility and affordability of home dialysis for kidney care patients; increase access to lab testing and preventive screenings; and cover care for activities of daily living (ADLs) through Medicare.

Essentially, the bill is not so much a do-or-die piece of legislation, but an overall message from united members of the home-based care ecosystem that says, “If we really want to give patients the opportunity to stay home, these are the things that have to change,” Drobac explained.

Increasing access to home-based care

One of the main benefits of the proposed bill would be an expansion of all types of care in the home, no matter the acuity level.

By increasing access for Medicare patients, home-based care providers and supporting companies stand to benefit.

“This piece of legislation starts to paint the picture that there’s more care that can be performed in the home,” Kevin Riddleberger, co-founder and chief strategy officer at DispatchHealth, told HHCN. “All the way from low acuity to high acuity and last-mile services.”

The Denver-based DispatchHealth is an in-home medical care provider that serves over 50 markets across the U.S. The company has raised over $700 million in funding to date.

DispatchHealth’s vision, Riddleberger said, is to be able to deliver care in the home, whether it’s through its own services or its partners.

To that point, advocates believe the bill would create more avenues for partnerships, and for overall growth.

“This certainly provides more flexibility for us to add on services moving forward,” Riddleberger said. “The one that aligns with us well is in-home diagnostics. Today, we’re able to perform portable imaging studies and X-rays inside the home and can bill for that technical component, but there are transportation fees on top of that to be able to deliver that care.”

Under the ECHA, providers like DispatchHealth would be able to bill those transportation fees and ultrasounds to Medicare.

Home infusion, after all, is another major pillar of the proposed bill.

“If you take a closer look at what’s in the bill, these are things that really could and should be done in the home,” Drobac said. “If you have pneumonia as a senior, you have to stay in the hospital to get an infusion. My mom was in the hospital for three weeks with pneumonia when she could have been at home.”

While expanding these services into the home is a clear benefit to providers, it’s also convenient for patients.

“If you take a typical senior, having them go get their lab drawn or to get infusion services, it’s not an easy task,” Riddleberger said. “Depending on the day, their mobility or transportation situation, that could be a three- to five-hour process. This provides more flexibility for seniors to be able to receive greater access to these types of services.”

The bill doesn’t just push for more care types in the home, it would also help cover the costs involved with that care.

For instance, Doug Robertson — director of health care regulation and compliance at Right at Home — pointed to the travel and mail costs that come with in-home labs.

“This addresses not only in-home infusion services but also allows certain test results to be conducted, and then have those lab results shipped to a processing center where they would be able to evaluate the labs,” Robertson told HHCN. “There needs to be reimbursement for travel costs and mail costs associated with in-home labs. Medicare does not pay for that currently. Home dialysis needs to have Medicare reimbursement for staff assistance as well. This bill would do that.”

Right at Home is an Omaha, Nebraska-based home care franchise company with over 600 locations in the U.S.

The bill would also address staffing, which is top of mind for almost all home-based care providers today.

“A lot of this is about the workforce,” Drobac said. “The workforce has to be ready to be in the home and we have to give them more opportunities. For example, one of the main reasons that people aren’t using in-home dialysis is because there’s not the staff to support it. We talked a lot about the patients, obviously, but this is also about the caregivers and the people that have to stay in the hospitals with them.”

The bill would provide grants to home health agencies, health systems and other organizations to help build the pipeline for caregivers and also create a task force for nursing certification standards for home care.

Potential cost savings

Whenever new legislation is introduced, one of the chief concerns is whether it will save or cost money.

There is optimism that this proposed bill could lead to savings.

The ECHA has a targeted benefit that would allow for a maximum of 144 hours of ADL assistance for Medicare beneficiaries.

This part is key, Robertson said, because it targets those who don’t qualify for Medicaid, but also don’t have an income level that exceeds 400% of the federal poverty level.

“ATI Advisory and Long Term Quality Alliance discovered that Medicare beneficiaries with two functional impairments cost Medicare $26,000 a year, nearly twice as much as someone without functional impairment,” Robertson said. “If you can get some assistance with ADLs to this frail demographic shortly after discharge from a hospital — which this bill would do — you might be able to make sure that they have nutrition in the home, give them the reminders to take medication, assist them with bathing and dressing and be there to potentially save them from a fall. All of these add up and [patients] can avoid emergency room visits and hospital readmissions.”

That would also create new clients for home-based care providers.

“It opens up a new opportunity to gain clients that we don’t currently have,” Robertson said. “Because folks that have less than $78,000 worth of income who don’t qualify for Medicaid, they’re not going to be able to pay out of pocket for these various services. They’re going to need assistance, which Medicare would do if this bill were to pass.”

The bill’s future

There’s still a long road ahead for the ECHA.

The hope is that, because it is so wide-ranging, at least some of its provisions will pass.

“The likelihood of that it’s really unknown,” Riddleberger said. “You don’t know what the tenor is going to be when you go to D.C. and go on these types of lobbying trips. Especially coming out of the pandemic, some of us were wondering if we would hear legislators use the tone of resorting back to our traditional ways of delivering care. And I heard the opposite. Whether it was from a telehealth perspective or the positive feedback from the hospital-at-home waiver program, I was pleasantly surprised by the awareness of what we’re trying to accomplish.”

The post Why Advocates Aimed For A ‘Catch-All Bill’ With The Expanding Care In The Home Act appeared first on Home Health Care News.

Home-based care has experienced a series of symbolic wins in 2023, many of which came from President Biden himself or his administration. But not all home-based care providers feel like victors.

Home-based care is a broad term, and there is a large chunk of providers that haven’t felt the warmth from policymakers in Washington, D.C., of late.

While the president is directing encouragement – and potential resources – toward home- and community-based services (HCBS), self-directed home care and non-medical home care in general, Medicare-certified home health providers have been left behind.

Plain and simple, Medicaid is winning a theoretical policy battle over Medicare, especially as it pertains to home-based care. And therefore, no matter how many times the benefits of home-based care are touted, Medicare-certified providers remain in a tough spot.

“It’s cheaper if we provide the ability for [seniors] to stay in their homes,” Biden said in Philadelphia as he released his proposed budget in early March. “It’s not only the right thing to do, but it’s cheaper for the taxpayers.”

The catch-all term “home-based care” has garnered excitement and lifted up popular models like hospital at home during the public health emergency.

But to best utilize the magic of home-based care, all payer sources have to be leveraged.

That’s not happening right now, which is an issue. And that is the topic of today’s exclusive, members-only HHCN+ Update.

Medicaid, Medicare and home-based care

When the Biden administration first unveiled Build Back Better, a multi-billion dollar investment in HCBS was proposed. There was support for home care in Medicaid, but not in Medicare.

Since then, the administration has continued to support the idea of home care, but only a segment of it. Even if the billions of dollars proposed for HCBS haven’t come to fruition yet, FMAP enhancement led to better Medicaid outlooks in various states, allowing for them to expand support and access to HCBS.

Then, last week, the president announced an executive order and 50-plus directives to government agencies, a few of which were centered around home-based care.

Among them: increased home-based personal care and primary care for veterans; considerations that would uplift the caregiver workforce through Medicaid; and further support for self-directed home care.

That was in addition to the $150 billion the administration allocated in support of HCBS over the next decade in its proposed budget back in March.

Yet, in 2022, the Centers for Medicare & Medicaid Services (CMS) proposed one of the harsher payment rate decreases in modern history to home health care services – an aggregate cut of 4.2% for CY2023. It also foreshadowed future “clawbacks” for perceived overpayments in previous years to home health agencies.

The agency ultimately backed off the immediate cuts, but only to a certain extent. In the final rule, a 0.7% aggregate bump was given to providers, but the ostensible increase was only due to inflationary adjustments included. For all intents and purposes, a -3.925% adjustment was still implemented.

And home health providers are expecting yet another cut in CY2024.

It raises the question: Are policymakers in Washington, D.C., actually committed to improving care and reducing costs through home-based care?

“The [Medicaid-Medicare discrepancy] has only gotten worse,” health care policy expert Lisa Grabert told me. “And I say that based on comments that have been made at the highest level of political rhetoric. The president says he doesn’t want to cut Medicare, and the speaker says he doesn’t want to cut Medicare. I understand from a political perspective why that’s attractive. But we’re not seeing a lot of progress made.”

Grabert is a research professor at Georgetown and Marquette universities. She focuses on post-hospitalization issues within the Medicare program and has previously served as a Capitol Hill aide on the U.S. House of Representatives Committee on Ways and Means.

Providers would argue that one of the best ways to keep costs down in Medicare would be to invest more in home health services, as it is one of the only subsectors effective in saving the overall health care system money.

Instead, while HCBS gets more attention, CMS is looking to cut home health payments, which is a short-sighted view that could lead to near-term savings that will spark long-term problems.

Home health providers are already rejecting referrals at an all-time rate due to staffing woes, which will inevitably force more seniors into facility-based care, a far more expensive option.

“There’s this narrative out there that our margins are super rich, and therefore, we need to cut them back,” Michael Johnson, the head of home health and hospice at Bayada, recently told me. “But a big part of the picture is being left out by CMS, especially as Medicare Advantage increases in penetration.”

Due to that narrative, there’s thousands of home health providers concerned about keeping their heads above water in the next year.

“When [MedPAC] puts out their reports, they could say, … ‘This only represents this percentage of home health care that is delivered,’ just so people have some sense on the full margin picture,” Johnson continued. “Something so it makes clear to the reader, particularly on Capitol Hill, that there’s another part of the story you have to dig into. That’s what worries me, that that part is not in there.”

The Medicare Payment Advisory Commission (MedPAC) has recommended payment cuts to home health care for years. While its recommendations are not often adhered to, readers of its reports are certainly not led to believe that home health care may, in fact, require more investment.

Home health providers are caught in backwards logic, they believe.

“And to the extent that, when you do pursue innovative care – and it might generate savings – it still might play poorly politically, because savings typically are interpreted as a cut [elsewhere],” Johnson said.

There has been legislation introduced to try to fight back against cuts to home health payments, such as the Preserving Access to Home Health Act and the Choose Home Care Act, which would have expanded the home health benefit. Both stalled out.

Just last week, another bill was formed in an effort to get personal care covered by Medicare. Its promise remains to be seen. The Moving Health Home coalition is one of the driving forces of that legislative effort.

The post Why Federal Support For Home-Based Care Is Missing The Mark appeared first on Home Health Care News.

This is because most of the biggest issues have already been addressed by Congress and the Centers for Medicare & Medicaid Services (CMS).

“Congress addressed the face-to-face encounter side of it, so we’re not going to be losing as much as we might have, if that hadn’t happened,” Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News. “For example, CMS early on in the pandemic made permanent the ability of home health agencies to use virtual visits, if authorized by the treating physician or treating practitioner.”

This means that the required face-to-face encounter for home health services can take place through telehealth.

Another factor that will potentially lessen the negative impact of the PHE ending is the Acute Hospital Care at Home waiver — which was originally tied to the PHE — getting an extension through the omnibus spending bill, Moving Health Home Founder Krista Drobac told HHCN.

“We were successful in decoupling the waiver related to acute care in the home from the PHE at the end of last year when we secured the two-year extension,” she said. “Now we’re focused on educating Congress about the other barriers that didn’t get waived during the PHE but are necessary for providing patients more options in the home.”

Drobac noted that Moving Health Home is pushing for a bill that will potentially be introduced in the House.

“It will give patients the options for care in the home,” she said. “There’s a lot of pieces that are still missing related to home infusion, home dialysis, home-based primary care, home-based imaging, home-based labs and even Medicare personal care services. We’ve taken a look across the full spectrum of all the things that need to change in order for a patient to truly be able to stay home in a variety of different cases, so we’ll be introducing legislation there.”

Still, there are some concerns providers should keep their eye on with the PHE coming to an end in the spring.

“We’ve heard from several of our mission-driven home health members that they are concerned with the end of the waiver that allows for therapists to perform the initial and comprehensive assessments for all patients,” Mollie Gurian, vice president of home health and HCBS policy at LeadingAge, told HHCN in an email. “Given the nursing shortage, home health agencies have appreciated the critical flexibility to utilize therapists to do the initial assessments on home health patients in order to initiate care, even when they are nursing based. We encourage CMS to consider ways to extend this flexibility in places with extreme nursing shortages.”

There are also some administrative flexibilities, regarding training and supervision activities, that Dombi believes CMS should consider maintaining on a permanent basis.

Ultimately, Dombi pointed out that the PHE was an opportunity for CMS and providers to learn what was truly administratively necessary and what wasn’t.

“In some respects, the home health agencies might have an increased appreciation for some of the structures that are there for assuring quality of care, but even more importantly, we think CMS has gained knowledge about overdoing it with regards to administrative structure,” he said. “Maybe that process isn’t something to keep layering on top of, in order to achieve an end that you can sometimes get to in more efficient ways.”

The post How The Public Health Emergency Helped Cut Regulatory Red Tape For Home Health Agencies appeared first on Home Health Care News.

Those providers did so, and now they’re wondering what comes next. With regulatory uncertainty moving forward, the hospital-at-home momentum has been put on pause – but not because of patient preference or provider enthusiasm.

“There is over 250 hospitals and 100 health systems across 30-plus states that have now been granted CMS waivers,” Biofourmis CMO and co-founder Maulik Majmudar said on a Moving Health Home webinar Tuesday. “However, it is also clear that a sizable part of the country does not have any offerings today. And more importantly, the number of CMS waivers granted in the last few months has been on a decline.”

The Boston-based Biofourmis is a tech-enabled at-home care enabler. The startup recently reached unicorn status.

Indeed, there are plenty of hospitals that have been approved to provide hospital-level care in the home under the CMS waiver. But many have not begun to do so given the regulatory cliff they face. The Acute Hospital Care at Home waiver is tied to the PHE, which could be ending by the end of this year.

Some health systems have found other mechanisms to provide hospital-at-home care independent from the waiver. There is also introduced legislation that would extend the Acute Hospital Care at Home waiver by two years past the PHE. But nothing yet has been set in stone.

And thus leads to the halted momentum: only two hospitals in the country have treated more than 2,000 patients under the hospital-at-home waiver, according to Majmudar.

“The key point is that there’s a lot of opportunity and room for technology to drive both safe and effective deployment of these programs, but especially in a way that allows us to achieve scale,” he said.

The resulting hesitation from the regulatory holdup has spurned innovation, and also providers’ ability to learn from their mistakes on the fly as they scale.

At the same time, there are health systems – like Advocate Aurora Health, for example – that love the opportunity to provide this care in the home, but not exactly as its allowed right now under the waiver.

“We certainly support the continuation of the waiver,” Dawn Doe, the VP of value-based programs and continuing health at Advocate Aurora Health, also said on the webinar. “But we ask for more flexibility on the structure, and the entities that can provide the program, for us as an integrated health system.”

For instance, as currently constituted, the waiver makes it so Advocate Aurora Health is forced to have its 27 hospitals all have different hospital-at-home programs.

That, Doe said, just doesn’t make sense for Advocate Aurora based on how it’s structured.

“We would like to see reimbursement models that really provide patients the ability to stay in their home while avoiding expensive institutional care,” Doe said. “And that the waivers for telehealth and remote monitoring reimbursement be made permanent. This not only improves patient outcomes, but will also address the strain on staffing resources.”

Home health providers’ involvement

New reimbursement models for hospital at home and staffing elements of the programs are top of mind for all providers.

In order for a new reimbursement vehicle to come out of CMS, the next step would be a demonstration project, which Moving Health Home and others are advocating for.

On the staffing front, there have actually been encouraging signs that employees enjoy working in the confines of a hospital-at-home program.

“These types of models really help us lean into those needs for our nursing staff,” Jordan Holland, the VP of value-based contracting at Compassus, also said on the webinar. “We’re able to attract and engage nurses – to keep them from potentially leaving the industry – through new innovative models like this.”

The Brentwood, Tennessee-based Compassus offers home health care services, plus infusion therapy, palliative care and hospice care. Its network includes about 200 locations across 30 states.

Compassus is an example of a traditional home-based care provider that’s gotten its hands on the hospital-at-home business, a good sign for others that may want to do the same.

To date, the company has cared for over 600 patients in a hospital-at-home model.

“What really keeps me up at night, in particular, is making sure that there’s an appropriate reimbursement model to support this level of staffing and this level of comparative productivity to a typical home health model,” Holland said.

The post Given Regulatory Uncertainty, Hospital-At-Home Models Are Losing Momentum appeared first on Home Health Care News.

The National Association for Home Care & Hospice (NAHC) and Moving Health Home are among the two groups that answered CMS’ request for information.

In July, CMS released that request for information seeking public comment on the MA program. Comments were to be submitted by Aug. 31, 2022.

“The significance is that CMS is beginning to evaluate the plans more closely in terms of provider relations and approaches to health care delivery for enrollees and how the plans can improve health care services for these beneficiaries,” Mary Carr, vice president of regulatory affairs at NAHC, told Home Health Care News in an email.

Broadly, the comment period gave home health stakeholders the opportunity to affect potential future rulemaking on various aspects of the MA program. This is notable because Medicare Advantage enrollment continues to grow — having more than doubled over the last decade.

In fact, Medicare Advantage has 28.4 million beneficiaries, or 45% of the Medicare population. By 2030, Medicare Advantage is expected to have over 52% of total Medicare enrollment, according to data from the research and advocacy organization Better Medicare Alliance.

With enrollment on the rise, it’s likely that providers will become even more entangled with health plans offering Medicare Advantage. And as this happens, it’s the responsibility of providers and plans to work together, NAHC President William A. Dombi wrote in the organization’s comments to CMS.

“It is imperative that the [MA] plans and the provider community work together to ensure patient-centered, high quality health care is provided to all beneficiaries,” he said.

This comment period is also significant because it gives home health stakeholders the floor to share their point of view. In the past, providers have been vocal about the challenges surrounding MA.

Specifically, providers have struggled with receiving fair rates for the services they deliver. NAHC took the time to directly address this in their comments.

“[Providers] continue to struggle with the payment structures and payment rates for care

by the MA plan,” NAHC wrote. “MA plan reimbursement for home health services is below the cost of care in many plans. With the growing proportion of home health patients enrolled in MA, that level of reimbursement jeopardizes the ability of the HHA to continue to operate.”

Overall, NAHC addresses the questions that CMS lays out while offering recommendations. In order to make sure that all enrollees receive the care they need, NAHC suggests that CMS focus on language.

“All communications with enrollees, including service/claims determinations, should be in plain language using the medium of language best understood by the specific enrollee,” NAHC wrote.

In its comments, NAHC also criticized the misinformation surrounding MA.

“Much of the information provided to the public regarding MA plans is misleading in terms of the limitations of MA plans and benefits of choosing traditional Medicare,” the organization wrote. “Plans should be required to use uniform content and display format in describing benefits and

cost within each plan. For example, CMS should require the plans to use side-by-side

comparisons for cost sharing, utilization data and how provider networks differ from traditional Medicare.”

NAHC also noted that there is confusion among beneficiaries when it comes to what the individual MA plans offer.

“Enrollees may believe they are required to choose an MA plan for their Medicare benefits,” NAHC wrote. “All MA plan marketing should be subject to CMS approval for accuracy and comprehensiveness and celebrity endorsement or promotions should be prohibited. All MA plan marketing should include a reference regarding an option to enroll in traditional Medicare and include information as stated in the previous response.”

On its end, the Washington, D.C.-based advocacy coalition Moving Health Home believes that CMS should urge MA plans to provide access to in-home care through the network adequacy standards.

“The scope could focus on certain specialties where in-home care is appropriate or on specific patient populations who may benefit the most from in-home care such as high-cost, high-need patients,” the organization wrote. “The existing process for requesting an exception to network adequacy requirements should remain for those plans who are unable to offer in-home care, or who believe it is inappropriate for their patient populations.”

Moving Health Home also suggests that CMS replicate the MA telehealth bonus.

“CMS now provides a 10-percentage point credit towards meeting time and distance standards for affected providers in states that have certificate of need laws,” Moving Health Home wrote. “The telehealth and the CON credits can be combined together to reduce the percentage of beneficiaries that are within the maximum time and distance requirements. Under this option, CMS could replicate one or a combination of these policies to encourage MA plans to cover in-home services.”

In addition to this, NAHC pointed out the important role telehealth played in home health care during the public health emergency.

“The value of telehealth will continue even after the PHE ends and will likely remain an essential tool for HHAs that provide care in the home to vulnerable populations,” the organization wrote. “Telehealth should be equally available as a benefit under MA Plans and traditional Medicare as it brings value to enrollees and improves access, especially for the homebound.”

Ultimately, NAHC hopes that CMS will ensure there is uniformity of coverage for home health services among Medicare Advantage plans and traditional Medicare.

“We also hope that beneficiaries are fully informed of the differences in the offerings between the plans and traditional Medicare,” Carr said. “Further, we hope that the plans recognize home health care as an important, if not necessary, step along the care continuum in ensuring that beneficiaries obtain their maximum level of health and avoid unnecessary health care costs.”

The post Home Health Stakeholders Voice Their Concerns To CMS Over Medicare Advantage Program appeared first on Home Health Care News.

Whether it’s home health, personal or in-home primary care, many home-based care advocacy groups and trade associations have been able to establish their organizations as champions of a particular lane.

It’s upon this foundation that the Washington, D.C.-based Moving Health Home has been able to lay the groundwork for its goal of mobilizing policymakers to thrust health care into the future, and into the home.

What sets Moving Health Home apart from many of the existing advocacy-focused organizations is the cross-sector approach it has taken.

Right out of the gate, Moving Health Home was able to call a distinctive set of organizations its  members. This includes heavy hitters like Amazon Care (Nasdaq: AMZN), Intermountain Healthcare, Home Instead Senior Care, Signify Health Inc. (NYSE: SGFY) and many more.

Editor’s note: Late Wednesday, Amazon confirmed that it was shutting down Amazon Care.

Currently, Moving Health Home has 27 member organizations.

The upside of bringing all of these organizations together is the ability to address various aspects of home-based care in a way that promotes holistic care, and expands care-at-home opportunities on multiple fronts.

Home Health Care News recently caught up with Moving Health Home Founder Krista Drobac to discuss all of this and more. Highlights from that conversation are below, edited for length and clarity. In addition to her position at Moving Health Home, Drobac is also a partner at consulting firm Sirona Strategies.

HHCN: The Moving Health Home coalition was originally formed last year. The goal was to change federal and state policies to expand at-home care. Can you start with briefly recapping some of the gains you’ve seen on this front since the coalition’s inception?

I think we are starting to break through on the idea of expanding more care in the home.

Originally, we would say health care in the home, and people would think of home health or home and community-based services (HCBS) and Medicaid. What we’re saying is, those two sets of benefits are foundational to care in the home, but we can do so much more. We can do in-home primary care, diagnostics, more dialysis, more in home infusion, hospital-at-home. The sky’s the limit in terms of what can be done in the home, through technology and various personnel, but there are policy barriers that need to be broken down. I think we have finally started to break through Congress, and other policymakers, thinking only about home health care or HCBS.

Moving Health Home’s member organizations are from a diverse set of home-based care backgrounds. Can you talk about the significance of having all of these organizations as part of the coalition?

We think that it’s important to have cross-sector representation in the coalition. There are already well-established associations in town that represent the interests of an industry. There are really good home health or HCBS established groups in town. Kidney dialysis and infusion have well established associations. We wanted to have the broader message not be about any one particular service. We wanted it to be about the patient wanting to be at home, and what services do we need to offer for a patient to have a real option to be at home.

I’ll give you an example. If you have pneumonia today, you’re more likely to be admitted into a hospital. You might see the home infusion industry advocating to increase the ability for a patient to go home if they have pneumonia. But think about all the other services that then also need to be available. Maybe, for example, personal care services. Do you have someone that is in the home that can help you? We’re trying to look at the patient in the center of a care episode and then all of the different services that need to be available, instead of one use case and one service that may not be enough for a holistic episode of care.

What are Moving Health Home’s current areas of focus?

Our goals are really to change policy. There are state policies that need to be changed, but we’re focused at the federal level. Our federal priorities center around three pieces of legislation, as well as some administrative changes that we are working with the Biden administration to try to put in place. The legislative initiatives center around hospital at home, SNF at home and then a broader expanding care in the home bill.

For hospital at home, we do have a full legislative proposal. We are trying to socialize that proposal on the Hill. As a baseline, we need an extension of the Acute Hospital Care at Home waiver that was issued during the public health emergency. If we’re not able to get the extension, we do actually have a demonstration project that Congress could drive to allow patients to continue to have this service in the home. It’s not just the legislation that we’re working on, it’s also educating people about care in the home. We have a video in the works right now showing how patients can receive hospital-level care at home. We also share evidence and statistics around how it’s working today with the hospitals that are offering it.

For SNF at home, we are supporting the Choose Home legislation that was put forward by the home health industry. Our ideal scenario would be that a patient could be admitted to the home and then discharged to the home, if we had a hospital-at-home and a SNF-at-home program.

The third piece of legislation is more of a catch-all bill that includes all of the other things that need to be available to patients. Primary care, diagnostics labs, personal care services, dialysis, home infusion — all those sorts of things that are also central services in the home. That bill is the cross-sector, cross-industry, holistic, patient-centered bill that is the centerpiece of what we’re working on.

One of things we’re also working on with the Biden administration is rebalancing the primary care codes to not disincentivize out of institution care. CMS made changes to E/M codes that were budget neutral. They took money from the E/M codes that are used outside of institutions and increased care codes for inside institutions. We’d like to see those rebalanced, so that there isn’t a disincentive for primary care outside of an institutional setting.

What are some of the biggest challenges Moving Health Home has had to navigate since the launch of the coalition?

We did a survey last year about the perception of care in the home among Americans — not just of seniors. We found that the perceptions among Americans are very good. They think that you can receive high-quality care in the home.

Among policymakers, though, we get a lot of questions about how we provide high-quality care for a high-acuity patient in the home. Our job is a lot of education on how the services are provided. Then secondarily, what are the policy barriers to providing this care?

Then it’s the process of inspiring members of Congress and other policymakers to want to make these changes. The pandemic has helped a lot with this. Now there’s experience with care in the home. We can point to that experience and say, ‘It’s really good for patients and good for caregivers.’ We want to inspire lawmakers to want to make this a priority of theirs. I see this as a new frontier that we’re still building the foundation for.

You recently wrote an op-ed about how the cuts that home health proposed payment rule would essentially erode the effort to increase home-based care. Can you talk about the issue with the proposed rule?

I have to admit to being completely incredulous that we would consider cutting home health reimbursement right now. Think about the fuel costs and the workforce costs. Those two things alone should make us want to increase reimbursement for home health. Home health agencies are struggling to find people and obviously struggling to cover fuel costs. The idea of cutting home health right now just seems ill timed. We don’t want to have to be in a position where we’re defending the foundational aspects of care in the home, we want to build on those aspects. We can’t build on home-based care as it exists today if that foundation is eroding. We’ve stepped back to work with the home health industry to try to present the evidence for why these home health cuts are ill-advised.

We’ve had to mobilize completely around the cuts, so that’s really where we’ve been getting most involved.

Obviously, all the time that we’re spending working on this is time that we’re not spending on building on that foundation. It’s disappointing that these cuts were proposed. We’re hoping to see a final rule that rolls this proposal back.

Though home health care agencies really relied on telehealth amid the pandemic, providers aren’t reimbursed for delivering these services. What do you think it will take to finally move the needle on this?

As I mentioned, part of what we see our job being is inspiring policymakers to see the home as a site of care for the future. It’s where we should be moving.

If we can build the underlying support for the idea of care in the home, we’re better equipped to then make arguments for why all of these pieces need to be strong. I guess the contribution that we’re trying to make is broader messaging around the future, and how each of these pieces goes together. This is not just a home health care problem. This is an American senior wanting to age in place problem.

The post The Legislative Battles Moving Health Home Is Fighting On Behalf Of Home-Based Care appeared first on Home Health Care News.

Over the past couple of years, the amount of MA plans offering care services in the home has increased significantly.

Currently, 729 MA plans are offering in-home support services, compared to just 223 in 2020. Additionally, 147 plans are offering home-based palliative care in 2022, compared to only 61 in 2020, according to data from the ATI Advisory.

Companies such as Anthem Inc. (NYSE: ANTM), Centene Corporation (NYSE: CNC), Humana Inc. (NYSE: HUM) and SCAN Group are responsible for the plans that are offering the most in-home support services.

But access to at-home care services should not be viewed as just the cherry on top, according to Mary Beth Donahue, the president and CEO of Better Medicare Alliance (BMA).

“It’s very important to understand that these are not simply perks, or extras for many older adults on Medicare Advantage,” she said during a BMA and Moving Health Home (MHH) virtual event on Thursday. “These at-home benefits are a lifeline, enabling them to age-in-place, manage disease progression and live with dignity and independence.”

One company, Signify Health (NYSE: SGFY), is partnering with MA plans to deliver in-home care.

“We at Signify provide about 2 million in-home evaluations for the MA population,” Dr. Damien Doyle, vice president of medical affairs, home & community services at Signify, said during the event.

Dallas-based Signify is a tech-enabled, value-based care platform that partners with both health plans and health systems to deliver a variety of care services to patients in their homes.

Doyle referred to Signify’s utilization of its in-home evaluations as “invaluable.”

“During those in-home visits, we’re able to discern the unique challenges that beneficiaries are encountering,” he said. “Our partners, primarily MA plans and health systems, use this information to better tailor their services to their members.”

For example, if it’s determined that medication is an issue, the health and primary care team will look for solutions, such as shifting to mail order to avoid making the beneficiary have to travel to the pharmacy, Doyle noted.

When it comes to explaining the home-based care value proposition to MA plans, data has been the main tool of choice for BrightStar Care.

“The rates were unsustainable from the very beginning — they’re low — so we believed we needed to have data to show how home care can really reduce the overall cost of care,” BrightStar Care CEO said.

Chicago-based BrightStar Care is a home care and medical staffing franchise with more than 365 locations nationwide. The company provides medical and non-medical services to clients in their homes, as well as supplemental care staff to corporate clients.

BrightStar Care entered a partnership with Avalere Health in order to leverage the health care consulting firm’s access to Medicare part A and B claims data. BrightStar Care put this data up against its own population to demonstrate how they were lowering the overall cost of care.

“We had to be able to tell the story, backed up by data, as to how we improve results,” Sun said.

Specifically, the total cost of care for BrightStar Care clients was $30,000 lower compared to other Medicare patients.

“We’ve been very successful in being able to have our Medicare Advantage plans see our quality compared to others, and our outcomes compared to others, and we use our Avalere data to get that conversation started,” Sun said. “[BrightStar Care has] been able to get over 30%rate increases, as we’ve had some of the plans be able to see our data compared to others.”

Still, roadblocks exist around larger adoption of care in the home in the MA market.

One of these barriers is the lack of standardization across home care, Home Care Association of America CEO Vicki Hoak said.

“We have a bit of an identity crisis,” she said. “We’re dealing with this because we have no national standard right now for in-home support care. Only 30 states license in-home support care.”

In other words, when MA plans want to know a provider’s standards of care, the answer isn’t consistent across all of the states a provider operates in.

“The fact that we have to pause for a minute and say, ‘Okay, you’re in Illinois, this is what we’re permitted to do [here], you’re in California,’” Hoak said. “That in itself becomes a barrier.”

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