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What Home Health Providers Are Learning From HHVBP’s First Full Year
Home Health Care News / By Patrick Filbin
In the midst of the first full performance year for the expanded Home Health Value-Based Purchasing (HHVBP) model, providers are figuring out where they are succeeding and where there is room for improvement.
HHVBP continues to save hundreds of millions of dollars each year, according to the U.S. Centers for Medicare & Medicaid Services (CMS).
And the initial set of HHVBP scores — on the provider side — is influencing the operations of home health providers of all sizes.
“We are steering the entire company towards value outcomes,” Ananth Mohan, COO of Elara Caring, told Home Health Care News. “It adds to the complexity of how we do business, so you have to be sophisticated about it. With the midway point scores, it’s really geared us up and reaffirms that this is the way the world’s going to go.”
HHVBP scores
The HHVBP model, which CMS expanded from nine demonstration states to home health agencies across the country on Jan. 1, 2023, was implemented to incentivize home health agencies to improve the quality of care they provide to Medicare beneficiaries.
The goal of the model is to link Medicare reimbursement to the quality of care, rather than just the quantity or volume of services.
The way CMS does that is through quality measures and performance scoring. Those measures include patient outcomes, patient experience, process measures and timely initiation of care.
Each category has specific measures that contribute to the overall performance score. The performance period usually lasts a year. During that time, CMS evaluates the data that providers share, and, from that, a score is returned to providers that can negatively or positively affect their reimbursement.
After reviewing the scores Elara Caring received at the six-month point, Mohan is pleased with the early results. In particular, Mohan is encouraged in how the results have affected day-to-day operations.
“On the hospitalization front, the results made us think about being more programmatic,” he said. “It changed how we think about centers of excellence around certain diseases, how we think about which areas of the company where we’re more hospital-heavy. It’s also changed the way we think about things like remote patient monitoring. RPM is not incentivized today, so you’re essentially giving it away. But if you’re giving it away in this mode,l then it matters, because it drives outcomes.”
The Dallas-based Elara Caring is one of the largest home health, home care and hospice providers in the country, with about 200 locations across 17 states.
The HHVBP model has given Elara Caring insights into what is working and what isn’t working at different locations.
For instance, the midpoint check-in has reinforced the need for predictive tools.
“Otherwise, we’re always just looking backward,” Mohan said. “So, we built an in-house, custom predictive tool that our branches are able to use and see on a real-time basis what they’re good at and what they need to improve on. I continue to be impressed at how this resonates culturally with people. If you give them the right tools, they can make an impact. We’re seeing that.”
On the flip side, the early results have shown that reducing hospitalizations will be a “never-ending challenge.”
For patient satisfaction and OASIS scores, the simplified strategy is to see where improvements need to be made and to stay on top of them. For clinically-driven results, it’s a tricker task.
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Employers May Have to Pay More in 2024 as ACA Affordability Threshold Hits New Low for Second Year in a Row
SESCO Management Consultants
- Under the Affordable Care Act (ACA), applicable large employers (ALEs) that do not offer affordable minimum essential coverage to at least 95% of their full-time employees (and their dependents) under an eligible employer-sponsored health plan may be subject to an employer shared responsibility penalty. Generally speaking, coverage is affordable if the employee-required contribution for self-only coverage is no more than 9.5% (as adjusted each year) of the employee's household income. The adjusted percentage for 2023 is 9.12%.
- Adjusted Percentage for 2024. The adjusted percentage for 2024 will be 8.39%. This is a decrease of 0.73% from the 2023 affordability threshold of 9.12% and is the lowest affordability threshold to date.
- Federal Poverty Line (FPL) Safe Harbor. Making calculations based on each employee's household income would be administratively burdensome. Accordingly, there are three safe harbors for determining affordability based on a criterion other than an employee's household income; namely an employee's Form W-2 wages, an employee's rate of pay, or the FPL. If one or more of the safe harbor methods can be satisfied, an offer of coverage is deemed affordable. The FPL safe harbor is the easiest to apply, since an employer has to do just one calculation and can ignore employees' actual wages and is intended to provide employers with a predetermined maximum required employee contribution that will in all cases result in coverage being deemed affordable. Under the FPL safe harbor, employer-provided coverage offered to an employee is affordable if the employee's monthly cost for self-only coverage does not exceed the adjusted percentage (8.39% for 2024) of the federal poverty line for a single individual, divided by 12. For plan years beginning in 2024, a plan will meet the ACA affordability requirement under the FPL safe harbor if an employee's required contribution for self-only coverage does not exceed $101.94 per month.
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ATI: Medicare Advantage Plans Shrinking In-Home Support Options
McKnight’s Home Care / By Adam Healy
The number of Medicare Advantage plans offering in-home supportive services (IHSS) in 2024 shrunk to its lowest number since 2021, despite the popularity of these supplemental benefits, according to healthcare research firm ATI Advisory.
“In-home support services are down pretty significantly,” Bill Winfrey, a director at research firm ATI Advisory’s Medicare innovation team, told McKnight’s Home Care Daily Pulse. “It dropped down between seven and eight percentage points from last year to this year. So it’s a pretty significant drop in one particular benefit that previously had been very popular and offered pretty commonly across plans.”
The Centers for Medicare & Medicaid Services released its most recent batch of supplemental benefit data on Oct. 2, according to ATI Advisory. The number of MA plans offering IHSS in 2024 has decreased to 721, down from the record high of 1,091 in the previous year.
A declining number of MA plans offering IHSS doesn’t necessarily mean that 2023 was a high-water mark, he said. MA plans are constantly experimenting with their “menu” of supplemental benefits, resulting in fluctuations each year. Other supplemental benefits have been on the rise. The number of plans offering caregiver supports grew from 293 to 350 going into next year, and home-based palliative care has steadily increased from 61 plans in 2020 to 195 plans in 2024.
The reasons why IHSS offerings shrunk in 2024 could be varied and numerous, Winfrey noted, but there is no definitive cause for the decline. One possible explanation is that IHSS is costly, and it can present a tougher logistical puzzle than other benefits like transportation or meal delivery. Lacking data as to the quality and efficacy of IHSS providers can also make it a tougher sell.
Winfrey noted the benefit is relatively expensive to offer and challenging to deliver. “If you’re thinking from the plan perspective and you’re trying to figure out which benefits to offer, and you have a reasonably expensive, relatively complex benefit to offer, that introduces some questions on behalf of the plan in terms of whether that might be a benefit they want to offer,” he said.
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Medicare Premiums Set to Rise in 2024
Axios / By Maya Goldman
Monthly Medicare premiums covering physician and outpatient care will rise almost 6% next year as part of a series of hikes the Centers for Medicare and Medicaid Services announced Thursday.
The big picture: Though inflation pressures are receding, projected growth in health care spending is continuing to drive up the cost of care. A plan to repay providers for underpayments they received from a federal drug discount program is another factor, CMS said.
By the numbers: The standard monthly premium for traditional Medicare Part B coverage, which encompasses physician care, outpatient services and medical equipment, will be $174.70 in 2024, up from $164.90 this year.
- Medicare enrollees may see higher premiums based on their income.
- The annual deductible for all Part B enrollees will be $240, an increase of $14 from this year's $226.
- The deductible for Medicare Part A, which covers inpatient hospital care, nursing home stays and other services, will be $1,632 next year — a $32, or 2%, increase from this year.
Context: Medicare premiums haven't followed a standard trend line in recent years.
- In 2022, Medicare Part B premiums rose 15%, largely due to the hefty anticipated price tag for Aduhelm, the controversial Alzheimer's treatment.
- But Medicare's subsequent decision to limit coverage of the drug allowed premiums to come down about 3% for 2023.
Of note: Consumers also have the option to enroll in private Medicare Advantage plans. The average MA monthly plan premium next year will be $17.86, a 64-cent increase from this year's average.
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Please Take this Hospice Audit Survey
- GO HERE to take the survey
- All responses are confidential, no provider info will be shared
- Please respond by October 31, 2023
The National Association for Home Care & Hospice (NAHC) is partnering with LeadingAge, NHPCO, and NPHI to collect information on various audits of hospice claims to share with the Centers for Medicare & Medicaid Services (CMS). We sent a letter to CMS outlining all our concerns about the hospice audit process. (Read that letter here.) In a follow up meeting with CMS, there was a mutual desire to focus on correcting issues related to the audits and this information will be used for that purpose only. We are asking for your help to collect examples of these issues – with no protected health information – particularly of technical denials. We are keeping all responses confidential – no provider information will be shared. |
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