Lawmakers Press CMMI's Fowler on Lack of Cost Savings for Alternative Payment Models

Fierce Healthcare | By Emma Beavins

Republicans on the House Energy and Commerce Committee lambasted the failure of CMS’ Innovation Center to save U.S. healthcare dollars during a recent hearing on value-based care.
 
Republicans suggested a variety of drastic actions like stopping projects that haven’t demonstrated cost savings, slimming the Center’s funding or shutting it down.
The Center for Medicare and Medicaid Innovation (CMMI) is tasked with driving the transition to value-based care. It runs demonstration projects that test different payment models and strategies for CMS to engage in the healthcare system to improve patient outcomes. 
 
Several CMMI models pay for medical technology and virtual care, like telehealth services in the dementia-focused GUIDE and remote monitoring services in its primary care VBC model, Making Care Primary.
 
Republicans took issue with CMMI’s spending and lack of savings since the center's establishment in 2010 by the Affordable Care Act, which projected it would save nearly $80 billion over two decades. According to a September 2023 report by the Congressional Budget Office, CMMI spent $5.4 billion more than it saved in its first decade. In the next decade, CBO estimates CMMI will increase spending by over a billion dollars. 
 
Because of this, Republicans said CMMI has failed as a money-saving project for U.S. healthcare. Elizabeth Fowler, deputy administrator of CMMI, who has been at the center for three years of its 14 years in existence, fought back, saying that CMMI has engaged in valuable projects, even if it’s not yet reducing costs. 
 
Republican Chair of Energy and Commerce Cathy McMorris Rodgers, R-Wash., said CMMI is “unsustainable” and said she has, “a hard time believing any objective observer could look at the results thus far and describe CMMI as a success.”
 
Republicans tempered their criticisms with recognition that CMMI’s Accountable Care Organization REACH model has been successful in driving ACO creation and bringing more value-based care into the system.
 
Fowler spoke on behalf of the Center during the hearing. In her opening statement, Fowler enumerated the value of CMMI in driving the transformation of the U.S. healthcare system. When lawmakers drilled into why the Center has not generated savings, Fowler said CMMI’s voluntary participation model can make it hard to generate cost savings as providers can drop out or in as they please.
 
Fowler repeatedly stressed that CMMI views all its programs as successful because they generate important lessons for the Center. She also said that Congress should look at how CMMI is improving quality of care, which is another one of its statutory mandates…

Read Full Article

Medicaid Can Alleviate Heavy Home Care Costs for Medicare Beneficiaries, Study Finds

McKnight’s Home Care | By Adam Healy
 
The costs of home care can be a significant burden for Medicare beneficiaries with severe functional disability, but Medicaid coverage can help alleviate this financial strain, according to a new study published in JAMA Network Open.
 
Researchers analyzed data from 31,952 Medicare beneficiaries, including 17,286 with no functional disability, 10,562 with moderate and 4,104 with severe functional disability. They found that functional disability was associated with greater financial hardship from healthcare expenses, and the strain was especially pronounced for those with severe disabilities. These individuals averaged spending roughly $700 more each year on out-of-pocket healthcare expenses.
 
The cost of home care, and the accompanying equipment and supplies to facilitate in-home care, was the primary reason for these beneficiaries’ extra financial burden, according to the study. Individuals with severe functional disability were also far more likely to use home care services than those without, and they had higher rates of inpatient admissions and emergency department visits.
 
However, Medicaid coverage was an effective tool for limiting these beneficiaries’ financial hardships. Among dual-eligible beneficiaries, the researchers found no significant differences in out-of-pocket healthcare spending based on functional disability level. 
 
Meanwhile, among beneficiaries who were not dually eligible for both Medicare and Medicaid, the researchers found significant differences in healthcare expenditures based on the severity of an individual functional disability.
 
Greater investment in Medicaid programs such as home- and community-based services can help more beneficiaries take advantage of these savings, the researchers said. 
Additionally, expanding Medicaid eligibility also could improve access to home-based care services, they noted.
 
“Addressing the financial challenges faced by Medicare beneficiaries with functional disabilities could be alleviated through state and federal policies aimed at expanding coverage for home and community-based services,” they wrote. “To effectively address the financial strain experienced by Medicare beneficiaries with functional disabilities, the implementation of policy interventions is crucial. An essential step is expanding coverage for essential services, providing comprehensive support for this population.”

International Nurse Visa Pause Extended Despite Staffing Gaps

Modern Healthcare | By Mari Devereaux
 
The government paused its processing of new visa applications until fiscal 2025, leaving thousands of international nurses in limbo as they look to fill health systems’ pervasive staffing gaps.
 
Each year, a pool of around 8,600 eligible, internationally educated nurses compete with other professionals that have bachelor’s-level degrees for 40,000 employment-based visa slots. Because of “continued high demand” for employment-based visas — the main category that foreign nurses are eligible for — the State Department’s Bureau of Consular Affairs announced in its July visa bulletin that it will only consider applications with petitions filed on or before Dec. 1, 2021. This means for the rest of fiscal 2024, no more recent applicants will be granted visas, according to the June 5 notice.
 
The backlog could get worse, as the State Department said it may push its processing cut off date for certain employment-based visas back further next month or make the category unavailable for applicants altogether.
 
The U.S.’ visa backlog has been building since May 2023 when the processing times for nurse visas doubled from 9 months to 18 months.
 
While distressing, the State Department's latest move isn't as severe as previous actions the government has taken to catch up on applications, said Jasper Tolarba, founder and president of the Society of Internationally Educated Nurses in North America. 
 
“This is mild compared to before,” he said. “When I first migrated here, the visa retrogression was about 10 years behind. Now we're just talking about three years, so it’s not out of the ordinary.”
 
International nurses seeking to enter the country should stay focused on building theirs skills and meeting necessary requirements so they are ready to go when visa petitions are eventually processed, Tolarba said.
 
In 2021, immigrant clinicians living in the U.S. accounted for more than 18% of all healthcare workers, according to a Migration Policy Institute analysis of U.S. Census Bureau data. Some health systems are looking to international nurses as a possible staffing solution as the Biden administration's nursing home staffing rule and states' nurse staffing ratio standards add pressure to the existing workforce…

Read Full Article

CMS: Home Healthcare Spending Estimated to Grow by 7.1 Percent from 2025 to 2026, Surpassing Other Sectors

McKnight’s Home Care | ByAdam Healy
 
National spending on home healthcare is projected to grow faster than any other health sector in the years ahead, according to newly published data from the Centers for Medicare & Medicaid Services’ Office of the Actuary.
 
Between 2025 and 2026, national spending on home health care is expected to increase by 7.1%, a data analysis published Wednesday in HealthAffairs revealed. Projected spending growth in home health care should outpace all other categories including hospital care services (4.9%), physician and clinical services (4.8%) and nursing homes care (4.8%), and it is expected to grow even faster during the following years. Between 2027 and 2032, the sector will see spending growth of 8.1%, compared to hospital spending (5.6%), physician and clinical services (5.5%) and nursing home care (6%).
 
In 2022, home health spending increased by roughly 6%, CMS disclosed in a previous report.
 
Despite the pace of growth, home healthcare remains a relatively small spending category. CMS’ projections indicated that roughly $177.5 billion will be directed toward the segment in 2026. That compares to larger categories such as hospital care ($1.7 trillion), physician services ($1.1 trillion) and nursing home care ($237.6 billion). By 2032, home healthcare is expected to benefit from $282.7 billion in healthcare spending, while hospitals and nursing homes could see $2.3 trillion and $337.4 billion, respectively…

Read Full Article