In The News

Debt Ceiling Deal: What’s in, What’s Out of the Agreement to Avert US Default


WASHINGTON (AP) — President Joe Biden and House Speaker Kevin McCarthy have reached an agreement in principle on legislation to increase the nation’s borrowing authority and avoid a federal default.

Negotiators are now racing to complete the bill’s text. McCarthy, R-Calif., said the House will vote on the legislation on Wednesday, giving the Senate time to consider it before June 5, the date when Treasury Secretary Janet Yellen said the United States could default on its debt obligations if lawmakers did not act in time.

While many details about the deal are unknown, both sides will be able to point to some victories. But some conservatives expressed early concerns that the compromise does not cut future deficits enough, while Democrats have been worried about proposed changes to work requirements in programs such as food stamps.

A look at what’s in and out of the deal, based on what’s known so far:


The agreement would keep nondefense spending roughly flat in the 2024 fiscal year and increase it by 1% the following year, as well as provide for a two-year debt-limit increase — past the next presidential election in 2024. That’s according to a source familiar with the deal who provided details on the condition of anonymity.


The agreement would fully fund medical care for veterans at the levels included in Biden’s proposed 2024 budget blueprint, including a fund dedicated to veterans who have been exposed to toxic substances or environmental hazards. Biden sought $20.3 billion for the toxic exposure fund in his budget and Republican negotiators ensured Sunday that funding was left untouched.


Republicans had proposed boosting work requirements for able-bodied adults without dependents in certain government assistance programs. They said it would bring more people into the workforce, who would then pay taxes and help shore up key entitlement programs, namely Social Security and Medicare.

The agreement would expand some work requirements for the Supplemental Nutrition Assistance Program, or SNAP, formerly known as food stamps. It would raise the age for existing work requirements from 49 to 54, similar to the Republican proposal, but those changes would expire in 2030. The White House said it would at the same time reduce the number of vulnerable people — including veterans and people who are homeless — of all ages who are subject to the requirements.

Many of those changes will sunset in 2030, allowing Congress to measure the effectiveness of these changes and make changes if need be.


The agreement would rescind about $30 billion in unspent coronavirus relief money that Congress approved through previous bills, with exceptions made for veterans’ medical care, housing assistance, the Indian Health Service, and some $5 billion for a program focused on rapidly developing the next generation of COVID-19 vaccines and treatments.

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Home Health Value-Based Purchasing Model Lowered Medicare Spending


The decline in Medicare spending was driven by an $807 million reduction in inpatient hospitalization stay expenditures and a $235.8 million decrease in skilled nursing facility spending.
- The Home Health Value-Based Purchasing (HHVBP) Model reduced Medicare spending by $1.38 billion and improved care quality during its first six years, according to a report from CMS.
The CMS Innovation Center implemented the original HHVBP Model in nine states from January 2016 to December 2021: Arizona, Florida, Iowa, Massachusetts, Maryland, Nebraska, North Carolina, Tennessee, and Washington.
The model aimed to improve the quality of home healthcare services for Medicare beneficiaries by providing financial incentives to home health agencies for quality improvements. Home health agencies received performance scores for individual measures of quality of care that were combined into a total performance score to determine their payment adjustment.
In 2018, CMS adjusted Medicare payments by up to 3 percent. Payment adjustments increased yearly and peaked at 7 percent in 2021. The report assesses the model’s impact on quality and spending from 2016 to 2021, the six years of the original model.
Over 1,900 home health agencies across the nine states participated in the HHVBP model in 2021. Total performance scores were 6 percent higher among agencies in HHVBP states than those in non-HHVBP states.
Additionally, HHVBP states saw a 2.2 percent decrease in unplanned hospitalization rates and an 8.2 percent decrease in skilled nursing facility use among home health beneficiaries compared to pre-HHVBP implementation.
The HHVBP model was associated with a 1.5 percent reduction in emergency department use leading to inpatient admission, but this was offset by a 2.1 percent increase in outpatient emergency department visits.
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‘They’re David Without The Slingshot’: How Small Home Health Providers Can Gear Up For MA Negotiations

Home Health Care News / By Patrick Filbin
Getting to the negotiating table with Medicare Advantage (MA) plans and coming away with a good deal is tough enough for even the biggest players in home health care.
For smaller providers, it’s an even more daunting and intimidating task.
However, there are steps those smaller providers can take in order to become more attractive and valuable managed care organizations.
“I think the biggest challenge that providers have is they don’t have the data to show what they’re truly doing,” McBee Associates President Mike Dordick told Home Health Care News. “Providers need to be able to show value. There are plenty of agencies out there that can do the work — and some that’ll take low rates. But in order to get to the table, regardless of size, you need to be able to show your readmission rates, show that you have superior data and show that you have programs that no one else has.”
McBee Associates is a consulting firm that works with hospital, home health, hospice and skilled nursing clients.
Smaller home health providers are at a natural disadvantage when it comes to getting those more preferable MA contracts. It’s difficult for them to carve a path for themselves in concentrated markets where larger providers have significant footprints.
That’s where the proof of value becomes even more paramount.
“We’re focused on mining the data and understanding what the insurance companies want,” 
Continuous Home Care CEO Will Putman told HHCN. “One big thing is hospitalization rates. Another is getting care started on time — the initiation of care. Recently, we’ve seen a big push on transition of care appointments, so we’re making sure our nurses are helping facilitate that. Then it’s all about taking that data back to the insurance companies to show the value we provide them.”
Continuous Home Care is a Pennsylvania-based home health provider with about 350 employees. Today, the company’s revenue breakdown is about 40% traditional Medicare and 60% MA.
When negotiating with MA plans, Putman puts an emphasis on benchmarks and makes an assessment on whether Continuous could be a good partner.
“If we can keep the hospitalizations down, if we can show them that we can hit their benchmarks, then it becomes easier for us at the negotiating table,” Putman said. “If we can say we can provide good, quality care, can be done in less than 30 days and maybe in seven or eight visits instead of 12 or 15? Then we’re getting somewhere. Because then, not only are these payers getting quality care, it’s a cheaper value for these managed care insurers.”
Managed care companies obviously care about cost, Dordick said, but outcomes are as important as value-based care proliferates.
Unique, value-based programs in concentrated markets could be an avenue of success for smaller providers who have the ability to pivot easier.
“If you can show you’re providing better value than your competitors, that’ll give you a better chance for a seat at the table,” Dordick said. “The small providers have the ability to be more nimble, but they need the data to show why. Even with all of that, that doesn’t mean they’re going to get a seat at the table. But it gives you a chance.”
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After 3-Year Dip, Home Care Turnover Soars To 77%

Home Health Care News / By Andrew Donlan

The industry’s turnover rate was one of the biggest topics of conversation in home care in 2019.

And that was for good reason. The median rate had skyrocketed all the way to 81.6%, according to data collected by the research and education company HCP.

But since that point, it had significantly improved. From 2019 to 2021, the median turnover rate floated marginally from 64.3% to 65.2%. In 2022, however, it soared back to 77.1%, according to HCP’s 2023 benchmarking report.

“During COVID, we called them care heroes, we clapped, we celebrated – we did so well there,” Kristen Duell, chief marketing officer at HCP, told Home Health Care News. “Raising people up through all of that during those hard times. And now that those hard times have kind of passed, the recognition tends to slip. It just points to the need to stay focused and stay on recognizing and making sure employees feel valued through all of it, even when there’s not a pandemic.”

The 2022 data from HCP is taken from over 92,000 surveys with home-based care professionals.

In addition to recognition, training remains vital to reducing turnover.

“I think [training] is critical, that really should be at the core,” Jeff Knapp, chief people officer at Bayada Home Health Care, said last week during the HHCN Staffing Summit. “That’s simply a prime reason people leave, because they don’t feel like they’re able to access career development opportunities.”

The rise in turnover is obviously troublesome for the industry. In home-based care – where workforce shortages are significant – providers have seen retention as one of the only ways to mitigate staffing woes.

“Employee turnover in our industry has been high for years,” Amanda Sternklar, the director of marketing at HCP, told HHCN. “But it stayed relatively steady for the last couple of years. This year, with that jump to 77% turnover, that was obviously fairly surprising.”

One other factor contributing to higher turnover in home-based care generally could be the one-time sign-on bonuses that have been leveraged by home-based care providers over the last few years.

“There’s ample evidence that there are still a contingent of workers who are out there and really taking advantage of going from one sign-on bonus to another,” Amedisys Inc. (Nasdaq: AMED) Chief People Officer Adam Holton also said during the Staffing Summit.

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In-Depth Report Reveals Impact of Workforce Shortage on Home Care Staffing Efforts

McKnight’s Home Care / By C. MAX BACHMANN

The workforce shortage has had a staggering effect on staffing within the personal care, home health and hospice industries. But providers may be responding to it in the wrong way, a new report from Home Care Pulse, a software firm that provides satisfaction surveys, training and reputation management, suggests. 
Among the findings of the 2023 HCP Benchmarking report: Of the home health and hospice providers surveyed, 48.3% of respondents cited care professional shortages as the biggest threat to the growth of their business, but only 21.2% raised employee turnover as a threat. 
“[The data] suggests that the focus is on recruiting more employees, but not enough on retaining the staff you have,” HCP Chief Marketing Officer Kristen Duell told McKnight’s Home Care Daily Pulse. “Programs that improve retention, such as satisfaction surveys, robust training and applying for recognitions and certifications that show your commitment to your employees’ well-being will be the differentiators between those who struggle with staffing in the coming year and those who thrive.”
The impact of the workforce crisis on business is apparent in the findings. Three quarters of all post-acute care providers have had to deny care to patients so far in 2023 due to workforce shortages. The report  — which included data from an industrywide survey during the first months of the year — also found that 53.5% of home care providers and 60.3% of home health providers have consistently turned down care since January of this year. 
The higher percentage of home health providers rejecting care is notable, Duell said. 
“I don’t think it would be a surprise to anyone in the industry to say workforce shortages are a problem, but it’s surprising that home health is struggling the most,” Duell said. 

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