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Medicare Advantage Is Becoming a Bigger Home Health Payer, But Fundamental Challenges Remain
Home Health Care News / By Joyce Famakinwa
With Medicare Advantage (MA) enrollment on the rise, home health providers need to be primed to adapt to the changing market.
MA has played a larger role in the Medicare program over the last several years. MA enrollees have increased by 8.3%, on average, over the last five years, according to data from post-acute analytics and metrics firm Trella Health.
Additionally, enrollment increased by 9.5% between 2019 and 2020, with MA penetration reaching 46.6% in March 2021.
“Medicare Advantage is not a new concept or new program,” Michael Neuman, vice president of data science and engineering at Trella Health, told Home Health Care News. “What we’ve seen is that since the Affordable Care Act, more people are starting to become aware of these [MA] programs. There’s a lot more marketing out there. I think what is driving people into [MA] is the perception that fee-for-service is limited in terms of its network.”
In other words, people want plan flexibility, access to more providers and care that’s more tailored toward their specific medical needs.
Another factor driving the rise in MA enrollment is the growing population of individuals in the U.S. who are entering Medicare-eligibility age, according to Neuman.
“We know the boomers are now entering that age range and have been for a little while now,” he said. “That sheer influx and volume is also going to make those numbers climb. You’re going to see people enrolling in both fee-for-service and [MA], but it’s just going to be exacerbated by that volume.”
On the flip side, fee-for-service Medicare has seen a decline over the past five years. Specifically, enrollment in fee-for-service Medicare has been decreasing by 1.1%, on average…
…Though MA continues to grow, the bad news for providers is that these plans are not utilizing home health services as much as their fee-for-services counterparts.
One possible reason for this is because MA plans sometimes have trouble understanding home health’s role and value-add. Another reason is the authorization process that MA plans use may be limiting the home health access for enrollees, according to a 2021 report by KNG Health Consulting.
“Many of the home health care providers and researchers we interviewed indicated that there may be significant gaps in understanding what skilled home health care entails and the health benefits associated with home health care, among patients and providers outside of the home health care industry,” Elizabeth Hamlett, a senior research associate for KNG, told HHCN in August. “For example, multiple interviewees noted that home health care is often confused with community-based care, and that few are aware of the skilled nursing care or therapy services provided by home health agencies.”
This leaves providers in a precarious spot in the future, Neuman said during a recent National Association for Home Care & Hospice (NAHC) webinar.
“The danger is that there’s decreased patient volume,” he said. “This is going to happen in the near future if home health agencies are not starting to pay attention to what’s going on with regards to [MA], how patients are choosing and allocating services, and how plans are developing their networks.”…
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Part B Home Health Episodes Increased Dramatically in 2020
Home Health Care News / By Robert Holly
The demographic profile of home health users continues to skew older, with the vast majority of individuals also having three or more chronic conditions. The setting users found themselves prior to starting home health services additionally continues to skew toward the broader community.
That’s according to the 2021 Home Health Chartbook, released earlier this month by the Alliance for Home Health Quality and Innovation in partnership with Avalere Health.
The most recently available data shows that one-quarter of home health users are 85 or older, with one-third of users between the ages of 75 and 84. Just 41% of the home health population is under the age of 74, according to the Chartbook.
In comparison, nearly 63% of the overall Medicare population is under the age of 74. Just 10% of the entire Medicare population is above 85.
Similar to the overall Medicare universe, home health users overwhelmingly live in urban areas.
When it comes to medical complexity, the most recently available data shows that home health users typically have more chronic conditions compared to the broader Medicare population.
Nearly 19% of home health users have three chronic conditions, with nearly 21% having four chronic conditions. Over 43% of home health users have at least five chronic conditions, according to the Chartbook.
In 2020, 57% of the Medicare beneficiaries admitted for a hospital stay were later discharged to the community. About 34% were discharged to a formal post-acute care setting.
Of those, 13% were discharged to the home health setting, with 16% discharged to skilled nursing facilities (SNFs). The percentage of Medicare beneficiaries referred to home health after a hospital stay actually decreased in 2020 compared to prior years, when between 19% and 20% of post-acute care discharges went to the home health setting.
That could partially be explained by a higher mortality rate in 2020 associated with the COVID-19 pandemic.
Nearly 59% of home health episodes began with users coming from the community — not an institutional setting. About 27% of episodes were preceded by a short-term acute care hospital stay, with nearly 9% preceded by a SNF stay.
Another interesting trend revealed within the 2021 Home Health Chartbook is a significant increase in the number of Medicare Part B home health episodes last year.
In 2021, there were 6.38 million Part B home health episodes, compared to 3.01 million Part A home health episodes. Previously, 2011 had the most Part B home health episodes, with 4.48 million.
The full findings from the 2021 Home Health Chartbook are available here. |
Payment Due for Deferred Payroll Taxes
The Internal Revenue Service is reminding employers they need to pay off part of the deferral of payroll taxes permitted last year under the Coronavirus, Aid, Relief and Economic Security (CARES) Act. The CARES Act allowed employers to defer the deposit and payment of the employer's share of Social Security taxes during the "payroll tax deferral period" that began on March 27, 2020 and ended December 31, 2020. Fifty percent of the deferred payments must now be deposited by December 31, 2021, to be treated as timely and avoid a failure to deposit penalty. The IRS website provides more information on how to pay the CARES Act deferral amount. |
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Merck's COVID-19 pill significantly less effective in new analysis
By Manas Mishra and Michael Erman, Reuters
WASHINGTON — Merck & Co said on Friday updated data from its study of its experimental COVID-19 pill showed the drug was significantly less effective in cutting hospitalizations and deaths than previously reported.
The drugmaker said its pill showed a 30% reduction in hospitalizations and deaths, based on data from 1,433 patients. In October, its data showed a roughly 50% efficacy, based on data from 775 patients. The drug, molnupiravir, was developed with partner Ridgeback Biotherapeutics.
The lower efficacy of Merck's drug could have big implications in terms of whether countries continue to buy the pill. Interim data from 1,200 participants in Pfizer Inc's trial for its experimental pill, Paxlovid, showed an 89% reduction in hospitalizations and deaths.
Merck's shares fell 3.5% to $79.39 in morning trading.
Merck released the data before the U.S Food and Drug Administration published a set of documents on Friday intended to brief a panel of outside experts who will meet on Tuesday to discuss whether to recommend authorizing the pill.
The agency's staff did not make their own recommendation as to whether the pill should be authorized.
FDA staff asked the panel to discuss whether the benefits of the drug outweigh the risks and whether the population for whom the drug should be authorized should be limited.
They also asked the committee to weigh in on concerns over whether the drug could encourage the virus to mutate, and how those concerns could be mitigated.
Pills like molnupiravir and Paxlovid could be promising new weapons in the fight against the pandemic, as they can be taken as early at-home treatments to help prevent COVID-19 hospitalizations and deaths. They could also become important tools in countries and areas with limited access to vaccines or low inoculation rates…
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7 policies in Biden’s spending plan aimed at health equity
STAT News / Rachel Cohrs
WASHINGTON — Democrats have made big promises to tackle racial inequities across society, including in health care, since protests for racial justice swept the nation in 2020.
Until recently, it wasn’t clear how either lawmakers or the Biden administration would deliver on those goals — but some of the first concrete steps are now taking shape in the new spending plan Democrats are moving.
Embedded in the nearly $2 trillion plan are billions of dollars to help make health care services more accessible and affordable for Americans who slipped through the cracks of existing safety-net policies.
The health equity programs span the beginning of life, aiming to make birth safer for Black mothers, to the end, offering incentives to boost pay for home care services disproportionately provided by Black and Hispanic women. The package would also provide cheaper coverage options for low-income adults in states that haven’t expanded Medicaid under the Affordable Care Act — a population that is 60% people of color — and provide stable funding for coverage programs for children and people in the U.S. territories.
The package, dubbed the Build Back Better Act, has passed the House, but still has to clear the Senate without a single Democratic defection, and then will likely have to go to another vote in the House before proceeding to the president’s desk.
“This is historic legislation, and an incredible investment in health equity. There’s a lot of important provisions, and we need to get this across the finish line,” said Frederick Isasi, executive director of the consumer advocacy group Families USA.
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