In The News

Providers slam House for not delaying nearly 10% Medicare payment cuts in must-pass spending deal

Fierce Healthcare

Major provider groups were livid that a continuing resolution to fund the federal government also doesn’t stave off nearly 10% in cuts to Medicare payments set to go into effect on Jan. 1.
 
The Federation of American Hospitals and American Medical Association were upset that legislative language to fund the government through Feb. 18 does not delay cuts from several sources including the Sequester and PAYGO law. Other providers have been lobbying Congress fervently on the cuts.
 
“These cuts are unsustainable during normal times, and they are reckless during a public health emergency,” said Gerald Harmon, president of the American Medical Association in a statement Thursday. “The result of congressional inaction is that Medicare patients are certain to experience reduced access to care.”
 
The Federation of American Hospitals also warned that facilities are facing a “critical and growing workforce crisis” that the cuts would exacerbate, said President and CEO Chip Kahn.
 
The Surgical Care Coalition, a collection of 13 surgical professional organizations, slammed Congress for not taking action. 
 
"Instead of supporting health care providers, Congress chose to slash Medicare payments and harm the ability of providers to care for our nation’s most vulnerable," said American College of Surgeons Executive Director David Hoyt, M.D.
 
Providers are facing a 4% cut to Medicare payments under the Pay-As-You-Go (PAYGO) spending law, which triggers cuts to government programs if spending reaches a certain threshold. The American Rescue Plan Act triggered that threshold earlier this year.
 
In addition, pay bumps given to providers to help deal with the financial impact of the COVID-19 pandemic are going away.
 
Physicians are facing the removal of a 3.75% pay bump to their Medicare payments on Jan. 1. Congress last year also placed a moratorium on a 2% cut to Medicare payments created under sequestration but that moratorium will now expire after Dec. 31.
 
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Hospice Star Rating and CAHPS Hospice Survey Forum

On Thursday, December 16th, the Centers for Medicare & Medicaid Services (CMS) will host a webinar to share updates on the Hospital Quality Reporting Program.

During this webinar, CMS subject matter experts will provide information on the following topics: 

  • The Consumer Assessment of Healthcare Providers & Systems (CAHPS) Hospice Survey
  • Introduction of Star Ratings for CAHPS Hospice Survey

CMS will also answer questions at the end of the webinar.

Webinar Details

Date: Thursday, December 16, 2021

Time: 12:30 - 1:30 p.m. MT (times are subject to change)

Registration Link: https://attendee.gotowebinar.com/register/6804140110362859023

 

How Do You Want Your Life To Be Celebrated?

When my step father died we asked the priest we, as a family, had known for years to conduct the funeral. He apologized and said church rules were that he could not do a service in a church because it “wasn’t his church.” He didn’t have a church because he worked in a hospital. SO Don’s funeral was in a church that our family used to attend but conducted by a priest we didn’t know, who didn’t know us. It was a cold, impersonal service, an official, traditional church “send off” but not particularly comforting. 

Five months later my mother died and we were considering funeral options. We definitely didn’t want a reoccurrence of Don’s non-comforting experience. My sister and I contacted our hospital priest friend and asked if he could do some kind of a service at the funeral home. He said yes BUT he would be on call and at the last minute may not be available, that we should have a back up plan.

We did just that.  As a family we planned what to say, what to read, who to share, when to open it up for anyone to share. We were so pleased with our finished service that we told Father B. we didn’t need him for the service. We would do our own funeral at the mortuary and, if available, would he meet us at the cemetery for an interment blessing? He agreed.

We, a family of daughters and son, grandchildren, cousins, nieces, and nephews, shared our love and appreciation for the matriarch of the family. We did it our way, with our words, our stories, our and others sharing. It was the best funeral I have ever gone to—-and I’ve been to many.

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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.

 
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