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Independence at Home Payment Model Didn't Yield Significant Savings, Quality Results for Medicare: Study
Fierce Healthcare
The Independence at Home payment model hasn’t improved quality or generated statistically significant savings for Medicare over the past six years, a new study found.
The study, published last week by Mathematica, looked at a model that gives physicians incentive payments for lowering Medicare costs and meeting a set of quality measures. The goal was to improve care coordination for patients especially after they leave the hospital.
“When examining dually eligible beneficiaries who received home-based primary care from any providers, Mathematica’s analysis found lower expenditures on institutional care and higher expenditures on home-based services—but no reduction in total Medicare or Medicaid spending,” according to a release on the firm’s analysis.
Mathematica examined its evaluation report in the sixth year of the model in 2019. The model was first created in 2010 and started in June 2012.
It found that the model’s payment incentive didn’t affect total Medicare spending in the sixth year of the model. Mathematica found the incentives led to a 1% decline in Medicare expenditures in year six of the model.
The reduction in total Medicare expenditures was driven largely by the largest service category of inpatient expenditures, which reduced spending by 4.1%.
The model also didn’t have an impact on hospital admissions the same year.
“We estimated that the payment incentive increased hospital admissions by 25 per 1,000 beneficiaries (1.4%) but this increase was not statistically significant,” the report said.
The analysis comes as the Center for Medicare and Medicaid Innovation (CMMI) has undertaken a strategic refresh of all its payment models, with a renewed focus on improving equity and becoming more streamlined. CMMI also wants to ensure reductions in spending aren’t the only metric models are evaluated against.
CMMI has also expanded several new models aimed at improving home care. Back in June, the Centers for Medicare & Medicaid Services proposed expanding nationwide a home health value-based purchasing model that rewards home health agencies for meeting certain quality metrics and spending initiatives. |
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OASIS Updates (12/09/2021)
More Lives Lost to COVID in 2021 than 2020
The New York Times reports, “More people in the United States have died from COVID-19 this year than died last year, before vaccines were available.”
Preliminary Data: Omicron Causes Milder Disease than Delta but is More Transmissible
The Washington Post reports, “World Health Organization officials said Wednesday morning that preliminary data suggest omicron presents a rapid increase in transmission but the variant causes milder cases of covid-19 than delta, which is still spreading across the globe. Although the emerging data is a cause of relief, WHO Director General Tedros Adhanom Ghebreyesus warned against drawing ‘firm conclusions,’ as he said it is ‘too early to be sure’ and more data and time is needed to have a ‘complete picture’ on the risks and impact of the variant.”
Another Federal Vaccine Mandate Blocked by Judge
WebMD reports, “A federal judge in Georgia temporarily blocked President Joe Biden's vaccine mandate for federal contractors on Tuesday, setting back the rollout of COVID-19 vaccine requirements.”
No Increased Risk of Heart Attack or Stroke in Older Adults from COVID-19 Vaccine
As reported on the Cardiovascular Business website, "COVID-19 vaccines are not associated with a heightened risk of adverse cardiovascular events among older adults, according to new research out of France. The analysis, published in JAMA, examined data from nearly 3.9 million adults 75 years old or older in France who received at least one dose of the Pfizer-BioNTech COVID-19 vaccine and 3.2 million who had received both doses." |
CDPHE Vaccine Mandate Updates
On August 30, 2021, the Board of Health adopted emergency revisions to 6 CCR 1011-1, Chapter 2 that established a requirement for all employees, direct contractors, and support staff to become fully vaccinated against COVID-19. Since that time, the Department has been working on revisions to these regulations, which will be presented to the Board of Health on December 15, 2021. The proposed revisions can be found here. For the December 15th meeting, the Board of Health will require all individuals who wish to provide public testimony to sign-up in advance at this link. Public testimony will be limited to one (1) hour, and signing up to testify does not guarantee there will be time for all individuals to testify at the hearing. To ensure your voice is heard, the Board encourages individuals to submit written testimony in advance of the meeting. Please email [email protected] regarding any questions you may have or if you would like to provide public comment or written testimony. Additional information on this meeting may be found on the Board of Health website. |
House Votes to Avert Looming Medicare Cuts
Modern Healthcare | By Jessie Hellmann
Providers are poised to get relief from pending Medicare cuts under legislation the U.S. House of Representatives passed Tuesday night on a party line vote, 222-212. It now heads to the Senate where it is expected to pass as soon as this week.
The bill falls short of what providers advocated but hospitals are relieved that Congress is taking steps to block tens of millions of dollars in reimbursment reductions slated to take effect next year, American Hospital Association President and CEO Rick Pollack said.
"The AHA is pleased that the House has recognized that now is not the time to make cuts to hospitals and physicians under the Medicare program," Pollack said in a news release. "Providers on the front lines of the fight against COVID-19 will not face additional imminent financial jeopardy as they continue to care for patients and communities."
The legislation, released by the House Rules Committee Tuesday, would delay 2% cuts to Medicare rates through March 2022 and punt a separate round of 4% Medicare cuts totaling about $36 billion to 2023.
The 2% Medicare cuts derive from the 2011 law that created budget sequestration requiring spending reductions across the federal government beginning in 2013. Congress and President Donald Trump delayed the cuts last year as part of the federal pandemic response. The bill would keep that pause in place until April 1, after which providers would see a 1% cut until June 30 and a 2% cut until the budget sequestration expires in 2031.
The 4% Medicare cuts are the consequence a budget law known as PAYGO that requires increases in the deficit be offset by raising revenue or reducing spending. The COVID-19 relief package enacted this year resulted in a larger budget deficit, triggering spending reductions.
The bill also includes a 3% increase in pay for providers paid under the Medicare Physician Fee Schedule.
Lawmakers argue the increase is necessary to avoid payment cuts stemming from changes the Centers for Medicare and Medicaid Services made to the fee schedule last year. Because of a budget neutrality requirement, payment increases for primary care doctors resulted in planned cuts to specialists. Congress stepped in to avert the cuts with a 3.75% increase for all doctors. Physician groups have asked Congress to again extend the pay bump.
"This legislation will bring some stability to the Medicare payment system to ensure patients can keep seeing their doctors," Rep. Kim Schrier (D-Wash.), who authored the bill, said in a news release.
Most House Republicans voted against the bill because it takes steps toward raising the debt ceiling, but it has enough support from Republicans in the Senate to pass. |
While Court Injunction Is in Place, CMS Will Not Enforce Vaccine Mandate
Two federal court rulings currently in place have created a nationwide preliminary injunction prohibiting the Centers for Medicare & Medicaid Services (CMS) and the US Department of Health and Human Services (HHS) from enforcing the recent Interim Final Rule that requires Medicare-and Medicaid providers subject to Medicare conditions of participation to have all staff vaccinated with some exceptions.
Last Thursday, December 2, CMS posted memo QSO-22-04-ALL, notifying state survey agency directors that it has suspended activities related to the implementation and enforcement of the vaccine mandate found in the Interim Final Rule as a result of the preliminary injunctions that are in effect.
Consequently, State surveyors must not survey providers for compliance with the requirements of the Interim Final Rule. Providers are still subject to State legislation that either mandates or prohibits the mandating of COVID-19 vaccination. |
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