CMS Releases Preview of Home Health Value-Based Purchasing Performance Reports

McKnight’s Home Care / By Adam Healy
 
Providers can now examine their Preview Annual Performance Reports for the Home Health Value-Based Purchasing (HHVBP) model, which will be crucial for determining potential reimbursement changes taking effect next year, according to home care consulting firm Healthcare Provider Solutions.
 
“This preview report introduces, for the first time, the percentage calculations showing how your 2023 results will affect your 2025 payments,” Melinda Gaboury, the cofounder and chief executive officer of Healthcare Provider Solutions, explained Monday. “It’s crucial that you review these reports right away, especially if you’ve been monitoring your calculations and believe there may be errors.” 
 
The Centers for Medicare & Medicaid Services uses claims data, Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) surveys and Outcome and Assessment Information Set (OASIS) results to score providers under HHVBP. Those who rank within the 51st percentile or higher will see either no change in their future reimbursement or a payment increase of up to 5%. However, providers that are scored at the 50th percentile and below will have their payment reduced between 0.2% and 5%. 
“Make sure to thoroughly review the content, especially focusing on the measures where your performance has fallen short,” Gaboury recommended. “As you review each individual element and its percentile ranking, aim for each measure to fall within the 50th to 75th percentiles to ensure your overall score is moving in the right direction.”
 
Experts recently offered strategies for achieving the best results under HHVBP at the National Association for Home Care & Hospice’s 2024 Financial Management Conference in Las Vegas. The most important quality measure affecting providers’ HHVBP scores is their rate of acute care hospitalization claims, so using tools like remote patient monitoring can help rein in avoidable hospitalizations, they said.
 
CMS is accepting requests for score recalculations up to Sept. 7, Gaboury noted. On Sept. 27, CMS is expected to release Preliminary Annual Performance reports, and on Dec. 2, it will send out the final reports. The reports are available in the Internet Quality Improvement & Evaluation System (iQIES), according to CMS.

MedPAC Encourages CMS to Begin Home Health Clawback Reductions ‘As Soon As Possible’

McKnight’s Home Care / By Adam Healy

While providers were dismayed to see the Centers for Medicare & Medicaid Services’ recent proposal to cut home health payment rates by 1.7%, the Medicare Payment Advisory Commission was disappointed that CMS did not take more drastic measures.
 
“The permanent reduction to the base rate proposed by CMS is lower than the update recommended by the Commission (−7%) as sufficient to maintain beneficiaries’ access to care,” the MedPAC wrote Thursday in a letter to CMS. “After applying CMS’s proposed update of 2.5%, the net adjustment to the base rate of 1.5% would leave FFS Medicare home health payment levels well above the cost of providing care to beneficiaries.”
 
MedPAC has long called for CMS to address what it perceives to be high margins generated by home health providers. In July, the commission reported that home health providers enjoyed aggregate Medicare margins exceeding 22% in 2022, having been paid “well in excess of their costs for more than 20 years.”
 
Meanwhile, home health providers have only seen Medicare rates decline in recent years. CMS cut home health rates by 3.925% in 2023 and 2.89% in 2024. Industry advocates have described the repeated reductions as “irrational.”
 
The industry also faces a looming temporary rate adjustment intended to claw back billions of dollars in overpayments related to the switch to the Patient-Driven Groupings Model. MedPAC urged CMS to begin recouping these funds as soon as possible.
 
“CMS has not yet indicated the policy or timing for implementation of the required $4.455 billion temporary adjustment, and it would be appropriate for CMS to make public its planned approach for implementing the temporary adjustment as soon as possible,” MedPAC wrote. “The Commission encourages CMS to begin the reductions required by the temporary adjustment as soon as possible. Taking this action would better align payments with costs and also reduce the temporary reductions necessary in future payment years.”

Prior Authorization Targeted by More and More States

Modern Healthcare / Michael McAuliff
 
While Congress appears stalled with its legislative proposals to streamline prior authorizations, many states have surged ahead and imposed tighter rules on health insurance companies.
 
According to a National Conference of State Legislatures database, 23 states enacted more than 43 bills related to prior authorization in the last few years, with 18 enacted so far in 2024 alone. The list doesn't appear to be comprehensive, however, and some of those new laws are narrowly focused.
 
The American Medical Association, which opposes restrictive prior authorization polices, reported last week that 10 states — Colorado, Illinois, Maine, Maryland, Minnesota, Mississippi, Oklahoma, Vermont, Virginia and Wyoming — have approved broad prior authorization bills it supports. The new Illinois, Minnesota and Virginia laws are not yet in the National Conference of State Legislatures database.
 
The use of prior authorizations, created to discourage unnecessary and costly care, have surged in recent years, to the consternation of providers and patients.
 
Prior authorizations in Medicare Advantage alone jumped from 30.3 million in 2020 to 46.2 million in 2022, the healthcare research institution KFF reported this month. In December, the AMA surveyed doctors and found that 94% reported delays caused by precertification requirements and 19% said delays had caused hospitalizations.

Seniors Name Aging in Place Challenges as Top Health-Related Barrier

McKnight’s Home Care / By Adam Healy
 
Challenges related to aging in place are the most prominent social threat impacting seniors’ health, according to a recent survey.
 
Alignment Health, a Medicare Advantage organization based in California, polled more than 2,000 seniors on the social and environmental factors that prevent them from receiving adequate aging-related care. The top barrier, cited by almost 70% of respondents, was aging in place. For nearly one quarter of respondents who experienced stress or anxiety in the past year, this was their No. 1 stressor. 
 
Difficulties surrounding aging in place affect residents of some states disproportionately. Respondents who lived in North Carolina, Nevada and Texas were the most likely to report difficulties surrounding aging in place as their top health-related barrier, Meanwhile, about 30% of seniors in Arizona and Nevada said issues related to aging in place are the primary reason they may have to skip medical care.
 
Lack of transportation was the No. 2 barrier threatening seniors’ health, the survey found. About 64% of respondents nationwide said that not having reliable transportation is the main reason they have skipped medical care in the past. In an effort to address this issue, rideshare technology firm Uber recently launched a new program to help home care providers connect clients with transportation services.
 
Respondents ranked economic insecurity third among social and environmental threats to their health. The cost of home care is a significant challenge for many, and the majority of seniors aged 75 and older cannot afford daily home health visits, according to a recent, unrelated study by the Harvard Joint Center for Housing Studies.
 
Other major challenges threatening seniors’ health included loneliness, a lack of support in the home and inadequate access to nutritious foods. One-quarter of survey participants said they feel lonely sometimes or often, and nearly 40% of respondents said they have little to no support from caregivers and family members to help them age healthily.