In The News

Given Regulatory Uncertainty, Hospital-At-Home Models Are Losing Momentum

Home Health Care News | By Andrew Donlan
 
The Centers for Medicare & Medicaid Services (CMS) gave health systems and providers the ability to take hospital at home as a concept and run with it during the public health emergency (PHE).
 
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.”

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Updates From Your HHAC Lobbyists

Minimum Wage Information: The lobbyists met with the Governor’s Office on Sept. 7th to discuss Denver Min. wage and the impacts it will have on the home care workforce, specifically HCBS providers. They were very receptive to the challenges and will be working on getting some details from HCPF on utilization to start pricing out our ask. They understood the ask of 8.9% increase for Denver and 8.2% for the rest of the state. We chatted a bit about the opportunities for retroactive billing in HCBS which gives us more flexibility to keep providers whole. They appreciated the conversation and we plan to stay in touch.

 

Long-Term Home Health Stakeholder Engagement
OCL is initiating stakeholder engagement for Long-Term Home Health through an introductory meeting. The meeting will convene Long-Term Home Health stakeholders and Office of Community Living leadership. The discussion will include stakeholder engagement preferences, identify topic areas and priorities, etc.

The meeting will be held:
Thursday, Sept. 29, 2022 | 1:30-2:25pm MT

Join via Google Meet

Join by Phone:
1-336-948-0083, PIN: 528 778 875 #

Reasonable accommodations will be provided upon request for persons with disabilities. Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify John Barry at 303-866-3173 or [email protected] or the 504/ADA Coordinator at [email protected] at least one week prior to the meeting to make arrangements.

 

A Brief Explainer on the Preserving Access to Home Health Act

Home Care Magazine | By Kristin Easterling

HR 8581/S 4605
 
The annual proposed rule for Medicare home health services, which the Centers for Medicare & Medicaid Services (CMS) released in June, includes an estimated 4.2% or $810 million decrease in aggregate payments. The rule would apply to calendar year 2023.
 
An analysis of the rule from the National Association for Home Health & Hospice (NAHC) revealed that 44% of home health agencies would operate at a loss in 2023 if the rule moved forward as proposed. The home health industry reacted strongly to the news and jumped into action to halt the proposed cuts.
 
“The stability of home health care is at risk because of CMS proposing the application of a fatally flawed methodology for assessing whether the Patient Driven Groupings Model led to budget neutral spending in 2020 and later years,” said William A. Dombi, president of NAHC.
“In its actions, the administration is undermining providers’ ability to deliver these critical services. … CMS is unfairly assuming all providers are bad actors. This is not acceptable,” said Katie Smith Sloan, president and CEO of LeadingAge.
 
“Considering that access to home-based care has become increasingly important to the health and safety of American seniors, it is very troubling that CMS would propose such steep rate cuts for next year and potentially even deeper cuts in the future,” said Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare.
 
In late July, Sens. Debbie Stabenow (D-Michigan) and Susan Collins (R-Maine), introduced the Preserving Access to Home Health Act. A House version of the bill soon followed, initially sponsored by Rep. Terri Sewell (D-Alabama).
 
If passed, the act would freeze current Medicare reimbursement rates for home health through 2026, but requires any make-up payments discovered then to be paid by 2032 in order to keep everything within the current 10-year budget cycle. It focuses solely on the payment issue, not on other adjustments in the proposed rule. The bill is designed to be budget neutral.

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Hospice Star Ratings Released: Enroll in the National Employee Retention Project

Last week, the first Family Caregiver Survey Rating Summary Star Ratings were released as part of the Hospice Care Compare August 2022 refresh. This is a new, publicly reported metric for all hospices with 75 or more completed surveys over the reporting period. In this release, the data showed an average 3.42 Hospice Star Rating for qualified agencies.

Did you know? Results of the National Healthcare at Home Best Practices and Future Insights Study showed a direct correlation between hospice turnover rates and reported Hospice Star Ratings. Read Report Here. 

 

MedPAC Explores Standardized Plan Options in Medicare Advantage

Fierce Healthcare | By Robert King
 
Affordable Care Act (ACA) plans may not be the only ones to introduce standardized options, as a key advisory panel wants to apply a similar strategy to the popular Medicare Advantage (MA) program. 
 
The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare issues, is researching how standardized benefit options would work for MA. The goal is to include the findings in an annual report to Congress next year and explore how standardization could help simplify choice for seniors. 
 
“I think there’s some reasonable evidence about the challenges of choice,” said Michael Chernew, the commission chair, during the panel’s Thursday meeting.
 
MA plans are required to offer services under Medicare Parts A and B, but there are some differences based on cost-sharing and other supplemental benefit packages. The MA program has gained in popularity in recent years and with it an abundance of plan choices for seniors.
 
Commission staff gave an example of how standardized benefit packages work by breaking out three options based on how generous they were for cost-sharing. What types of plans would be subject to the standard package would have to be decided and could be vital.
 
“This requirement would aim to ensure a minimum level of access to standardized plans, but its impact could be limited if the plans that insurers are required to offer are unpopular,” said MedPAC staff member Eric Rollins.
 
Letting insurers offer both nonstandardized and the standard options could also help reduce any disruption for existing enrollees but could reduce any gains from standardization, he added. Only offering the standardized benefit plans, on the other hand, could cause too much disruption.
 
There could be a benefit to insurers, though, by avoiding paying a broker that guides seniors through different plan options. 
 
“There’s a huge financial incentive for them,” said commission member Lynn Barr.
 
However, some commission members were concerned about the impact standardization could have on plan innovation. 

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