In The News

CMS: Concurrent Hospice Care Improves Quality, Reduces Costs

Hospice News | By Jim Parker

Allowing patients to receive concurrent hospice and curative care reduces health care costs and improves quality.

The U.S. Centers for Medicare & Medicaid Services (CMS) has released its fifth and final report on the Medicare Care Choices Model (MCCM), which studied the effects of allowing individuals to receive hospice care without foregoing other treatments. 

The agency launched the MCCM in 2016. Initially slated to complete in 2020, CMS later extended it until December 2021. Throughout that period, the model hit every one of its targets — reducing costs, improving quality and family satisfaction, and keeping patients in their homes.

MCCM yielded positive results for every population subgroup that the demonstration examined, according to Keith Kranker, principal researcher for Mathematica and lead author of the CMS evaluation report.

“This model basically worked for everyone we’ve looked at. We really didn’t find subgroups that were not benefiting from the model,” Kranker told Hospice News. “We looked across these different diseases that made people eligible for the model, and for all the diseases finding these kinds of quality improvements and cost savings.”

The model’s 7,263 enrollees were Medicare fee-for-service beneficiaries with a six-month terminal prognosis due to cancer, congestive heart failure, chronic obstructive pulmonary disease, or HIV/AIDS.

These patients had also received a referral to one of the program’s participating hospices, met eligibility criteria for the demonstration and made the choice to enroll in MCCM.

Among patients who had died before the demonstration ended, MCCM reduced Medicare expenditures by $7,604 per enrollee, about a 13% reduction compared to a control group. Hospital admissions dropped 26% and emergency department visits fell by 12%.

Enrolled patients were also more likely to transition to the traditional Medicare Hospice Benefit. MCCM enrollees were 18% more likely to elect the benefit, and their average length of stay reached 42 days compared to 19 for a control group. These patients were also able to stay in their homes longer than non-participants, 183 days compared to 178.

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Home Health Providers Are Beginning To Tie Clinician Compensation To Value-Based Care Success

Home Health Care News | By Patrick Filbin

Home health providers are adjusting their operations to be better set themselves up for value-based care.
One thing they need to be sure of, though, is that those adjustments are making their way down to the front line.
“From an agency standpoint, providers are thinking as their reimbursement model changes, how are we being judged against competitors and how are patients choosing us?” Jonathan Dickinson, senior manager of financial consultation with SimiTree, told Home Health Care News. “They’re noticing that a lot of it is based on quality. Value-based purchasing is going to impact their revenue. Now they’re starting to ask themselves, ‘How do we then incentivize our clinicians who are doing the work in the field to emphasize that quality?”
Operationally, providers are shifting to models – both inside fee for service and outside of it – that require better quality of care, sometimes with fewer visits.
But that message needs to make its way down to the frontline workers.
“Providers are saying, ‘You’re giving us great quality as a clinician — even though you may do 10 visits or less a month — we’re still going to pay you the same incentive,’” Dickinson said. “Because the quality is going to drive our reimbursement. We typically are seeing this more as a quality incentive around a quarterly bonus.”
For example, a provider could pay a clinician $30 for every visit after their goal in a quantity-based incentive program.
Now, providers are paying clinicians $10 for every additional visit and the other $20 is tied to quality incentives that go back to a patient’s outcome.
“If you have a clinician who continually just says, ‘I’m just going to do visits and not care about quality,’ they’ll still get a small portion of incentive and revenue, but it won’t be as big as if they were to actually drop back the number of visits and do more quality work,” Dickinson said.
To execute this type of plan, communication is paramount.
The more an agency can articulate how the quality of care is tied to compensation, job security and the overall health of the business, the better off everyone will be.
“The more an agency can correlate the fact that winning on value protects their jobs and allows them to have compensation increases, the more they’ll be able to understand how this actually impacts them,” Frontpoint Health CEO Brent Korte told HHCN. “It deeply impacts them.”
Based in Dallas, Frontpoint is a home health and hospice company that specifically tailors its business model to take on Medicare Advantage (MA) patients. It’s also betting big on value-based arrangements.
At the end of the day, agencies can’t pay clinicians more when they don’t have the money to spend, Korte said.

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Home Health Providers Take Aim At CMS’ ‘Black Box’ Approach To Policymaking

Home Health Care News | By Joyce Famakinwa
Enough time has passed since the CY 2024 home health payment rule was finalized for providers to dive into its details, mull them over and respond. 
Though the rule is more favorable than the proposal the U.S. Centers for Medicare & Medicaid Services (CMS) first introduced in June, home health providers are not pleased with the final outcome. 
CMS didn’t address – and in some cases furthered – the concerns that many providers and industry stakeholders raised in the months and weeks leading up to the rule’s finalization. 
The rule comes with a 0.8%, or $140 million, aggregate increase to home health payments. In June, CMS proposed a 2.2% aggregate decrease for 2024, which would have been an aggregate decrease of $375 million. 
Plus, the rule finalized a -2.890% adjustment, which is half of the cut originally proposed back in June. 
“My initial reaction was that where we landed was an improvement over what was proposed,” Choice Health at Home CEO David Jackson told Home Health Care News. “I believe home health provides substantial economic upside for the Medicare program and for the beneficiaries. I continue to disagree with the methodology, as far as how it’s viewed as budget neutral.” 
When the rule was first released, some providers felt that relief. But that quickly wore off.
“I quickly came to the stark realization that CMS still was continuing with deep cuts — albeit they were kicking them down the road — despite the prevalence of respected third-party data highlighting that cuts have made problems with access to care a reality, not just an assumption,” David Totaro, chief government affairs officer at Bayada Home Health Care, told HHCN. 
Similar to Totaro and Jackson, other providers have voiced pushback to what they believe is CMS doubling down on its intention to implement the permanent adjustment cuts in the coming years. 

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Hidden Quality Statistics Hinder Home Health Discharge Planning, Study Finds

McKnight’s Home Care | By Adam Healy
Hospital discharge planners are often limited in their access to home health agencies’ quality statistics, which can impair patients’ decision-making and potentially result in suboptimal post-acute care, according to new research.
The study, published in Sage Journals, surveyed 58 discharge planners representing 27 hospitals. While the majority considered information pertaining to the reputation, quality, availability of personal protective equipment and COVID-19 safety strategies of post-acute care facilities to be important, most reported that this information was not readily available. 
A home care agency’s reputation was an important piece of information to 98% of respondents, but only 34% found this data accessible. Less than 1 in 5 discharge planners could easily find information regarding an agency’s availability of personal protective equipment. And any information regarding COVID-19, such as safety measures in place or whether the agency was currently treating any infected patients, was largely inaccessible, according to the discharge planners.
These statistics are often sought by people leaving hospital care; without the data, discharge planners are unable to inform those aspects of a patient’s decision.
“Our study suggests that discharge planners were largely unequipped with accessible information to help patients understand COVID-19 exposure risk. Fewer than a quarter of discharge planners had readily available information on agencies’ COVID-19 competencies,” the study said. “This is particularly concerning, given that discharge planners report a third of their patients referred to home health having questions on COVID-19.”
But even when these data are readily available, it is sometimes not used at all during discharge planning, according to the study. Only about a quarter of discharge planners helped patients interpret post-acute care providers’ quality statistics, which could be due to a lack of adequate information or insufficient discharge planning practices at hospitals, the study noted.
The researchers made several recommendations for preventing these issues. First, they recommended that the Centers for Medicare & Medicaid Services gather more data on post-acute providers like home health agencies, and make it easily available to interested parties. They also advised CMS to create incentives for post-discharge follow-ups with patients to reaffirm whether a provider’s actual quality was actually consistent with expectations.


Education, Care Coordination Key to Preventing Unnecessary Revocations of the Hospice Benefit 

Hospice News | By Jim Parker

Revocations of the hospice benefit can have serious adverse effects on patients and families, as well as providers. Understanding the causes and repercussions of these incidents can help operators prevent them, when appropriate.

Live discharges can occur for a number of reasons, including the patient or family changing their minds about receiving hospice care, or the patient improves and no longer needs those services. A patient may choose to resume curative treatment, or they might move out of the hospice’s service area.

In some cases, a frightened patient or a patient in crisis may call an ambulance or visit and emergency room, prompting revocation of the Medicare Hospice Benefit in order to receive hospital care.

Causes of Revocations

When it comes to revocations, fear and a lack of education about hospice are often significant factors, Sara Sprague, manager of clinical quality improvement, for Providence Hospices of Orange County in California, said at the National Hospice and Palliative Organization’s (NHPCO) Annual Leadership Conference.

“Families don’t fully understand hospice and the scope of hospice, what it provides. There’s also a lack of clarity on disease progression and prognosis, caregiver burden, distress, or difficult to manage symptoms,” Sprauge said at the conference. “You also have caregivers’ reluctance to administer morphine, and the response time of the hospice when compared to 911, and the family’s difficulty in accepting the patient’s own mortality. What’s interesting here when you look at these items is that some of them are within the control of hospice.”

About 15.4% of patients who were discharged from hospice in 2020 did so while they were still alive, according to NHPCO. Of those, 5.7% were due to revocations, and 2.2% transferred to a different hospice.

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