Value-Based Care Through Postacute Home Health Under CMS PACT Regulations

The American Journal of Managed Care, February 2022, Volume 28, Issue 2 (Racsa et al.)

ABSTRACT

Objectives: To assess in a Medicare Advantage population (1) whether discharge to home health, compared with discharge to home, following an inpatient stay subject to CMS postacute care transfer (PACT) regulations, is associated with better outcomes or lower expenditures and (2) whether the impact differs among subpopulations.

Study Design: Claims-based retrospective cohort study.

Methods: Instrumental variable (IV) analysis, with prior hospital-level probability of discharge to home health as the IV, to control for unobservable as well as observable confounders.

Results: Compared with 15,071 patients discharged to home, 4160 patients discharged to and receiving timely home health services were 60% less likely to be readmitted within 30 days and 37% less likely at 90 days. Total expenditures from time of admission to 90 days post discharge were 11% lower in the home health group. The association of discharge to home health with reduced readmission and reduced costs varied by subpopulations defined by surgical vs medical diagnosis-related group and receipt of intensive care management following discharge.

Conclusions: The PACT policy may be promoting greater value by reducing readmissions while lowering total expenditures for patients who do not require intensive postacute care. Findings were in contrast to those of previous studies, in which discharge to home health has been associated with higher rates of readmission. Earlier studies did not control for unmeasurable confounders, involved narrowly defined populations, and used older data.

Read Study at https://doi.org/10.37765/ajmc.2022.88827

Colorado Found to Violate ADA

HomeCare News

DENVER (March 4, 2022)—The Justice Department has concluded that the state of Colorado unnecessarily segregates people with physical disabilities in nursing facilities, in violation of the Americans with Disabilities Act (ADA) and the Supreme Court’s decision in Olmstead v. L.C. The department’s findings, detailed in a letter to Colorado Governor Jared Polis, follow a thorough and multi-year investigation into the state’s system of care for people with physical disabilities.

The ADA and the Olmstead ruling require state and local governments to make services available to people with disabilities in the most integrated setting appropriate to their needs, regardless of age or type of disability. However, many Coloradans with physical disabilities are denied a meaningful choice to receive the services they need in their own homes and communities. Community-based services that can help people live at home successfully include help bathing, dressing, managing medications and preparing meals.

“People with disabilities have too often been unlawfully segregated in institutions like nursing facilities,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “The Civil Rights Division will vigorously enforce the rights of people with physical disabilities, including older adults, to access the community-based services they need to age in place and thrive at home.”

“Older Coloradans and Coloradans with physical disabilities increasingly expect to remain at home as their support needs increase,” said U.S. Attorney Cole Finegan for the District of Colorado. “I’m hopeful this situation can be remedied so that individuals with physical disabilities are no longer isolated.” 

The department’s investigation found that a significant number of Colorado’s Medicaid-funded nursing facility residents are interested in transitioning to community-based settings and could successfully do so with appropriate supports. However, few Coloradans with physical disabilities who want to move out of their nursing facilities are able to do so. The investigation found that most residents are unaware of the services available to help them move and live successfully in the community. 

The right to receive needed services in the community instead of an institution has become particularly acute during the COVID-19 pandemic. Reports show that a significant number of all deaths from COVID-19 in the United States are linked to nursing facilities and other long-term care facilities. Enabling people to move out of nursing facilities and into the community can reduce that risk and satisfy the ADA by avoiding unnecessary institutionalization.

This investigation was conducted by the Civil Rights Division’s Disability Rights Section with the assistance of the U.S. Attorney’s Office of the District of Colorado. The full findings letter can be found here. Additional information about the Civil Rights Division’s Olmstead enforcement is available on its website at ada.gov/olmstead.

Biden Administration Launches Nationwide Test-to-Treat Initiative Ensuring Rapid ‘On the Spot’ Access to Lifesaving COVID Treatments

[The] Biden-Harris Administration is launching a new nationwide Test to Treat initiative that will give individuals an important new way to rapidly access free lifesaving treatment for COVID-19.

Through this program, people who test positive for COVID-19 will in one stop, be assessed by a qualified health care provider who can prescribe antiviral pills on the spot. This ensures that, if people who are at high risk for developing severe disease test positive and if administration of an antiviral is appropriate, they can get treatment quickly and easily.

The Test to Treat Initiative will also include new actions to educate the public about the availability of new treatments and the importance of starting them soon after the onset of symptoms; and provide information to health care providers about these new treatments.

A full fact sheet about this initiative from HHS can be found through the link below:

https://aspr.hhs.gov/TestToTreat/Documents/Fact-Sheet.pdf

Almost a Third of People Report Lingering Symptom 6-12 Months After COVID-19 Study

Almost a third of people report at least one ongoing symptom between 6 and 12 months after their coronavirus infection, a survey of 152,000 people in Denmark has found.

The study includes one of the largest groups yet of people who were not hospitalised with COVID, and followed them for longer than other major studies, the researchers from Denmark's State Serum Institute (SSI) said.

The questionnaire-based study suggested that the most commonly reported long-term symptoms were changes in sense of smell and taste, as well as fatigue.

Read more @ Reuters