In The News

CMS HOPE instrument Webinar (Registration Required)

Wednesday, May 12th (12:00 – 1:00 p.m. MT)

The Centers for Medicare & Medicaid Services (CMS) will host a webinar to share updates on the Hospice Outcomes & Patient Evaluation (HOPE) assessment.

During this webinar, CMS subject matter experts will discuss the:

  • · HOPE background and objectives
  • · HOPE development and testing updates

CMS subject matter experts will answer questions at the end of the webinar, as time permits.

Registration Link: https://register.gotowebinar.com/register/69595102441857038

Participation Information

After you register, you will receive a dial-in number and webinar link. You will not be able to share your registration information as it will be unique to you. Please check your spam filter if you do not receive an email confirmation.

 

Democrats’ Push to Lower Medicare Age Raises Hopes, Concerns

Bloomberg By Tony Pugh | April 28, 2021 5:32AM ET

Congressional Democrats appear to have found common ground in a proposal that has animated both their progressive and moderate factions: lowering the Medicare eligibility age from 65 to 60—or even lower.
 
Supporters want to help fund the benefits expansion with $456 billion that Medicare could save over 10 years through President Joe Biden’s plan to let the program negotiate its own drug prices.
 
After the massive loss of jobs and employer-based health coverage due to Covid-19, Democrats say public support for their plan is strong. A recent Gallup poll found roughly 46 million Americans couldn’t pay for quality health care if they needed it. And even before the pandemic struck, 77% of Americans, including 69% of Republicans, favored letting adults ages 50 to 64 buy into the Medicare program, according to a January 2019 poll by the Kaiser Family Foundation.
 
Getting their policy goals accomplished, however, will still prove to be a heavy political lift.
Congressional Republicans have railed against expanding federal health-care programs and have shown no signs of budging. The powerful pharmaceutical lobby opposes Medicare negotiating its own drug prices. And “simply lowering Medicare’s eligibility age does not solve the core problem of affordability and would put at risk the existing coverage so many Americans rely upon,” David Allen, a spokesman for America’s Health Insurance Plans, said in a statement.

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In-Home Care Providers Must Break Through Barriers to Handle More Long-Term Care Volume

Home Health Care News
By Robert Holly | April 25, 2021
 
There are several trends shaping senior care in the United States, with two of the biggest being continued Medicare Advantage (MA) growth and the steady shift of health care into the home.
 
Yet if in-home care operators want to capitalize on those trends, they’ll have to break through traditional payment and operational barriers. That’s particularly true for home-based care entities looking to roll out new care models for patients who would have otherwise gone to skilled nursing facilities (SNFs).
 
The “SNF-at-home concept” has gained a lot of traction in the wake of the COVID-19 pandemic, but there are still plenty of questions left to answer, according to Anne Tumlinson, founder and CEO of the Washington, D.C.-based ATI Advisory.
 
“I think there’s a limit to what can be done in a home setting, and I worry about caregivers who are not really prepared to bring somebody home,” Tumlinson said at the 2021 Navigator Leadership Summit. “Whatever this model is, it’d better be robust.”
 
On the payment front, breaking through barriers means figuring out ways to make managed care work for providers. Despite steady MA growth, most home health organizations still lean on fee-for-service Medicare, while home care agencies largely remain stuck in the private-pay world.
 
About 43% of the nearly 63 million people eligible for Medicare enrolled in an MA plan for 2021. Looking ahead, MA enrollment is projected to clear 51% by 2025, potentially hitting 64% by the end of 2028.
 
“If your organization does not have a Medicare Advantage strategy that goes beyond just arguing over contracts, you need one,” said Tumlinson, who was speaking to SNF operators and in-home care executives alike.

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Health officials plan major research on COVID-19 long-haulers

Roll Call
By Mary Ellen McIntire
Posted April 30, 2021 at 6:00am
 
The National Institutes of Health is preparing to award grants in the next three weeks to researchers studying the long-term effects of COVID-19 and patients experiencing “long COVID.”
 
NIH Director Francis Collins told the Energy and Commerce Health Subcommittee this week that the agency expects laboratory research and imaging studies to be underway by the summer. The agency received 273 research proposals after Congress provided more than $1 billion for research into the long-term effects of COVID-19. 
 
Many people who have been sick with COVID-19, including some who had mild or no symptoms, reported dealing with additional symptoms long after their acute illness ended. The long-haul COVID-19 symptoms can range from fatigue or headaches to mental health issues or chronic pain. 
 
“Some of you have been suffering for more than a year with no answers, no treatment options, not even a forecast of what your future may hold,” Collins said during his opening statement Wednesday, referring to patients suffering from long COVID-19. “Some of you have even faced skepticism about whether your symptoms are real. I want to assure you that we at NIH hear you and believe you.”

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CMS extends joint replacement model for three years

Modern Healthcare 
Michael Brady
 
CMS' Center for Medicare and Medicaid Innovation on Thursday signed off on a three-year extension of the Comprehensive Care for Joint Replacement model.
 
It will now last through the end of 2024. The final rule changes the definition of an episode to include outpatient hip and knee replacements, modifies how the agency calculates target prices and reduces the number of reconciliation periods from two to one. It also makes changes to beneficiary notice requirements, gainsharing caps and the appeals process. Regulators expect the extension to save the Medicare program about $217 million over three years.
 
In addition to extending the CJR model, the final rule makes permanent a three-month extension of the model's fifth performance year, which will now end March 31. It was initially slated to end at the end of 2020. The rule solidified COVID-19 related flexibilities for the model's fifth performance year and new diagnostic related groupings for hip and knee procedures.
 
CMMI originally planned to continue the model through 2023. But it scuttled those plans in light of the COVID-19 pandemic, which wreaked havoc on the healthcare system. Policymakers waived or delayed several reporting and value-based payment requirements in response, but those exceptions will begin to draw to close alongside the public health emergency.
 
The CJR model is supposed to test if bundled payments and quality measurements for hip and knee replacements cause providers to boost quality and coordinate care from the first hospitalization and throughout the recovery period.
 
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