Beyond The Cuts: What Else Home Health Providers Need To Know About CMS’ Proposed Rule
Home Health Care News | By Patrick Filbin
When the U.S. Centers for Medicare & Medicaid Services (CMS) published its FY 2024 home health proposed payment rule, the 2.2% cut immediately became the focus.
But the nearly 300-page rule included dozens of other notable, proposed changes to home health care.
From Home Health Value-Based Purchasing (HHVBP) Model tweaks to a more focused approach on health equity, there are a number of developments that home health providers and stakeholders are keeping an eye on.
HHVBP
One of the major changes CMS included in the proposed rule deals with HHVBP.
Most notably, CMS is proposing to remove five quality measures and add three to the applicable measure set starting in 2025.
The three additions are around discharge function scores, discharges to the community and potentially preventable hospitalizations during home health care coverage.
“There are some significant updates to the VBP, not the least of which is the highest measure, which is currently acute care hospitalizations,” Nick Seabrook, managing principal and SVP of consulting at SimiTree, told Home Health Care News. “CMS is changing that now to potentially preventable hospitalizations. This may be the way to help offset that dynamic where, if you’re an agency that is hospital-based, you may have a higher rehospitalization rate because of the nature of the patients you take and their acuity.”
The new potentially preventable hospitalizations benchmark, Seabrook said, is CMS’ way of introducing a new algorithm that will try to level the playing field across the industry.
Another reason why that change is critical for home health providers to pay attention to is the weight of that measure in the overall VBP calculation.
“It’s still being proposed that 26% of your VBP score is weighted towards that one specific measure,” Seabrook said. “If you’re going to focus on any measure on your value-based purchasing measures, it’s going to be that one.”
Another change includes replacing the OASIS-based discharge-to-community measure with the claims-based discharge community post-acute care measure…
Read Full Article |
NHPCO Meets with CMS on Program Integrity Recommendations, Six-Month Update
NHPCO
Summary at a Glance
Yesterday, July 12, NHPCO met with the Centers for Medicare and Medicaid Services (CMS) regarding the ongoing fraudulent hospice activity, focused but not limited to activity in Arizona, California, Nevada, and Texas. CMS was represented by staff from the Office of Legislative Affairs, Center for Clinical Standards and Quality, Provider Enrollment, and the Center for Program Integrity. Congressman Blumenauer (D-OR), who has been a leading congressional voice on hospice issues, participated in the meeting. Representatives from the National Association of Home Care and Hospice, LeadingAge, and the National Partnership for Healthcare and Hospice Innovation also joined the meeting.
CMS provided the following updates on its program integrity efforts:
1. National Site Visit Project: Beginning earlier this year, CMS began a project to visit all 7,000 hospices across the country to deactivate non-functioning or shell hospices. CMS is close to finishing this project and will release more information about the results upon completion.
2. Enhanced Oversight: Starting today, July 13, 2023, CMS has implemented a “provisional period of enhanced oversight for hospice providers in Arizona, California, Nevada, and Texas.” This applies to any new hospice, a hospice submitting a change of ownership (CHOW), or a hospice undergoing a 100% ownership change that doesn’t fall under a CHOW, as described in MLN7867599 - Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, & Texas (cms.gov). Enhanced oversight will last anywhere from 30 days to one year and can include prepayment reviews, additional visits for providers not billing, and possible deactivation of the hospice’s provider number.
3. Hospice + HH Rules: CMS staff highlighted a number of provisions in both the Fiscal Year 2024 Hospice Wage Index proposed rule and the Calendar Year 2024 Home Health proposed rule, aimed at combating fraud. NHPCO has published detailed analyses of each proposed rule referenced here.
4. Hospice 90 Day Stay Review: In response to concerns about beneficiaries who do not qualify for hospice being admitted by fraudulent organizations, CMS is conducting a small pilot project with post-payment review of beneficiaries with a stay longer than 90 days. The goal of review is to target patients who should not have been admitted to hospice at all, covering billing between January 1 and December 31, 2021. CMS has contracted with the Supplemental Medical Review Contractor Noridian, which describes the project and the diagnosis codes it will be reviewing.
Of the 34 program integrity recommendations that NHPCO and other national stakeholder groups submitted to CMS Administrator Chiquita Brooks-LaSure in January of this year, CMS or Office of Inspector General (OIG) has acted on 17 of those recommendations. These four national hospice organizations will continue to work together and with other partners to drive solutions to stop the growth of fraudulent hospices and strengthen the hospice Medicare certification and survey process.
|
NHPCO Welcomes Congressional Reintroduction of the Palliative Care and Hospice Education and Training Act
NHPCO
NHPCO and its advocacy affiliate, The Hospice Action Network (HAN) are pleased to support the reintroduction of the Palliative Care and Hospice Education and Training Act (PCHETA) in the U.S. Senate. This bipartisan legislation (S. 2243) would invest in the training, education, and research required to ensure the hospice and palliative care workforce of tomorrow.
“Every American facing a serious or life-limiting illness deserves access to quality hospice and palliative care. We desperately need to train more professionals in the field of palliative medicine. Without efforts to address the existing workforce shortage, there will be only one palliative physician for every 26,000 seriously ill patients by 2030,” said COO and interim CEO of NHPCO, Ben Marcantonio. “Thank you to Senators Baldwin and Capito for your leadership in reintroducing the Palliative Care and Hospice Education and Training Act.”
Read Full Press Release |
Breaking: CDC ACIP Recommends RSV Vaccination for Older Adults
Drug Topics | By Lauren Biscaldi
The first RSV vaccines were approved by the FDA earlier this year.
Members of the CDC’s Advisory Committee for Immunization Practices (ACIP) have voted in favor of recommending recently approved respiratory syncytial virus (RSV) vaccines for use in adults aged 60 years and older after consulting with their health care provider.1 The first 2 RSV vaccines, from manufacturers GSK and Pfizer, were approved by the FDA earlier this year.2,3
Although some committee members were hoping for a broader recommendation, other members expressed concerns around a lack of data on vaccine effectiveness for adults over the age of 75 years as well as those in other high-risk groups.
Arexvy (respiratory syncytial virus vaccine, adjuvanted), manufactured by GSK, was approved by the FDA on May 3, 2023 to prevent lower respiratory tract disease caused by RSV in adults aged 60 years and older. The vaccine contains a recombinant subunit prefusion RSV F glycoprotein antigen (RSVPreF3) in combination with GSK’s priority AS01E adjuvant.
FDA approval of Arexvy was based on data from AReSVi-006 (NCT04886596), a landmark phase 3 clinical trial. Trial results showed that the vaccine demonstrated both statistically significant and clinically meaningful overall efficacy against RSV-associated lower respiratory tract disease in adults aged 60 years and older, as well as efficacy in older adults with at least 1 underlying comorbid condition.
Additional studies of Arexvy evaluated the coadministration of Arexvy and an FDA-approved influenza vaccine; 2 participants developed acute disseminated encephalomyelitis and 1 developed Guillain-Barré syndrome. As a result, the FDA is requiring GSK to conduct postmarketing studies to evaluate the signals of serious risks for each of these conditions.
On June 1, the FDA approved Abrysvo, a bivalent RSV vaccine manufactured by Pfizer, also for the prevention of lower respiratory tract disease caused by RSV in adults aged 60 years and older. Approval for Abrysvo was based on data from the phase 3 RENOIR clinical trial (NCT05035212), a global, randomized, double-blind, placebo-controlled study evaluating the efficacy, immunogenicity, and safety of a single vaccine dose in older adults. Study participants—over 34,000 adults—were randomly assigned 1:1 to receive the bivalent RSVpreF vaccine 120 µg or placebo.
Interim results published in the New England Journal of Medicine demonstrated efficacy against RSV-associated lower respiratory tract illness with at least 2 or 3 signs and symptoms; the vaccine group had 1.19 RSV cases per 1000 person-years compared with 1.52 per 1000 person-years in the placebo group. Adverse event rates were similar through 1 month after injection in in each group.
RSV is a highly contagious respiratory disease with seasonal circulation. Transmission typically begins in the fall and peaks during the winter months. In older adults, RSV can cause lower respiratory tract infections, leading to life-threatening pneumonia and bronchiolitis. Data suggest that RSV is responsible for 14,000 deaths in adults aged 65 years and older.
In terms of pricing, GSK expects their vaccine to be priced between $200 and $295 per dose. suggested a range of $180 to $270 a dose, but could not guarantee that the final price would remain within that range.
|
|
|
