Hospice Action Network (November Update)

It’s hard to believe that campaign season is almost over--but there is still so much work ahead before the year's end! While Congress is in recess, you can prepare for their return with HAN advocacy resources. 

Elections

Election Day is here! Use our Action Center Elections page to learn about your local voter registration and ballots.

The Latest
In the latest HAN blog, members of the MyHospice Ambassadors program reflect on six years of this special volunteer advocacy program and hopes for its future.

Veterans Day is November 11

Make a difference for our Veterans in hospice!

• Tell Congress to pass Gerald's Law (HR 234 / S 1330) for  seriously-ill Veterans and their families
• Advocacy Guide for Providers who Care for Veterans
• Veterans Issues One-Pager to share with legislative offices

Hospice Special Focus Program

The Hospice Special Focus Program (SFP) is not yet in effect. But providers must be prepared for its implementation and for legislative opportunities to fix this flawed program.

• The National Alliance for Care at Home has a page outlining the background of the program and the Alliance's actions on it. It includes Members-only resources available on this page including talking points.
• The page also offers research resources accessible to anyone, including this summary from McDermott+, a health care data analytics company, outlining the serious data issues in the hospice SFP's design. 

Congress Will Return Soon

Get ready! We have key priorities that must get over the finish line before end of year!

• Stay up to date on our supported bills and action alerts.
•  Check out our Advocacy 101 Toolkit for easy ways you can make a difference.
• Review our Policymaking 101 Guide for all things about how Congress works.

Thank you for all that you do to support hospice and palliative care. As the National Alliance for Care at Home advocates for better policies for patients and providers, we are stronger together!

Stephanie Marburger

Manager, Grassroots Advocacy

National Hospice and Palliative Care Organization | Hospice Action Network

Bipartisan Legislation Aims to Block Medicare Cuts, Boost Physician Pay in 2025

Fierce Healthcare | By Emma Beavins

Physicians and other healthcare practitioners may get a pay boost in 2025 through a bipartisan bill introduced in Congress on Tuesday. 

The proposed bill seeks to block planned Medicare pay cuts next year and would provide the first inflationary update to physician pay in years.

The Medicare Patient Access and Practice Stabilization Act would counteract the 2.8% cut to the conversion factor proposed by the Centers for Medicare and Medicaid Services (CMS) in the draft CY2025 Physician Fee Schedule. A stop-gap pay fix is usually enacted by Congress at the end of the year. 

However, the proposed one-year pay fix includes an additional 1.93% pay increase, which is roughly equivalent to half of the current Medicare Economic Index, the measure of inflation for physician practice cost. The total fix offered in the discussion draft is a 4.73% increase to current pay rates.

The bill was co-led by Reps. Greg Murphy, M.D. (R-N.C.), Jimmy Panetta (D-Calif.), Mariannette Miller-Meeks (R-Iowa), Ami Bera, M.D. (D-Calif.), Larry Bucshon, M.D. (R-Ind.), Kim Schrier, M.D. (D-Wash.), John Joyce, M.D., (R-Pa.) and Raul Ruiz, M.D. (D-Calif.).
A statement by Murphy’s office cites the American Medical Association’s analysis that physician pay has declined by 29% since 2001, through annual cuts to reimbursement and rising inflation.

"America's physicians are at a breaking point and access to high-quality, affordable care is at risk for millions of Medicare patients," Murphy said in a statement. "When a physician sees a Medicare patient, they do so out of the goodness of their heart, not because it makes financial sense. Medical inflation is much higher and the cost of seeing patients continues to rise. Unfortunately, reimbursements continue to decline, putting immense pressure on doctors to retire, close their practices, forgo seeing new Medicare patients, or seek a less efficient employment position. This bipartisan legislation would stop yet another year of reimbursement cuts, give them a slight inflationary adjustment, and protect Medicare for physicians and patients alike."

Jeffrey Davis, health policy director at McDermott+Consulting, said Congress recognized that it would take more than plugging the 2.8% cut proposed by CMS to counteract the annual pay cuts. Davis said the Medicare Patient Access and Practice Stabilization Act is the first nod to inflation doctors have gotten in years.

There are other bills in Congress that would make regular MEI adjustments to physician pay, but those bills have yet to pass. 

The final CY2025 Physician Fee Schedule is expected to drop in a matter of days. The final cut to the conversion factor may vary slightly from the proposed 2.8% cut, Davis said.
Depending on the final conversion factor cut, Congress may adjust the 4.73% pay raise.

“The introduction today of a bill to stop the ruinous Medicare payment cut that is scheduled to go into effect Jan. 1 is a vital sign that Congress is poised to act," Bruce Scott, president of the American Medical Association, said Tuesday in a statement. "Lawmakers must take action during the lame-duck session."

Home-Based Health Risk Assessments Drive $3.5B in Payments to MA, OIG Says

McKnights Home Care | By Adam Healy
 
Medicare Advantage companies’ questionable use of in-home health risk assessments led to billions of dollars in Medicare spending in 2023, according to a new report by the Department of Health and Human Services Office of Inspector General.
 
Altogether, MA generated approximately $7.5 billion in risk-adjusted payments from health risk assessments last year. While these assessments allow insurers to diagnose patients and evaluate treatment options, they may also be susceptible to misuse, OIG said. MA plans often do not conduct follow-up visits, and may rely on outsourced vendors to assess beneficiaries, approaches that could lead to inaccurate diagnoses and wasteful spending. 

Those assessments that were conducted in beneficiaries’ homes were particularly vulnerable to abuse, OIG noted, due to the lack of oversight that exists outside of healthcare facilities. Home-based HRAs were responsible for $3.5 billion — nearly half — of Medicare risk-adjusted payments to MA in 2023, while HRAs conducted using only a review of beneficiaries’ chart data drove another $1.3 billion.
 
“In-home HRAs and HRA-linked chart reviews generated almost two-thirds of the estimated $7.5 billion in risk-adjusted payments,” OIG’s report said. “In-home HRAs and HRA-linked chart reviews may be more vulnerable to misuse because these tools are often administered by MA companies or their third-party vendors and not enrollees’ own providers. Diagnoses reported only on these types of records heighten concerns about the validity of the diagnoses or the coordination of care for MA enrollees.”
 
The majority of these risk-adjusted payments were generated by just 20 MA companies, OIG said. These companies drove 80% of the entire $7.5 billion the Centers for Medicare & Medicaid Services spent on MA risk-adjusted payments in 2023.
 
MA insurers’ use of in-home health risk assessments has come under scrutiny previously. Earlier this year, a study published in HealthAffairs estimated that inflated risk coding from HRAs could lead to as much as $12.3 billion in Medicare overpayments each year. A later study found that the financial impact of these HRAs has grown over time.

The insurance companies have responded to these claims. In August, UnitedHealth Group issued a statement discrediting allegations that its HRA program, called HouseCalls, was used to inflate risk-adjusted payments.

‘We’ve Had To Walk Away’: Home Health Providers Saying ‘No’ To Medicare Advantage

Home Health Care News | By Andrew Donlan
 
The Federation of American Hospitals (FAH) released a statement Thursday regarding recent investigations into Medicare Advantage (MA) plans. 
 
Those investigations included concerns around claim denials, as well as discrepancies between MA plan practices when compared to traditional Medicare. 
 
It is yet another example of health care providers and advocates pushing back. It also shows that home health providers are not alone in their gripes with MA plans.
 
“Where there is smoke, there is fire – and today’s news is further evidence that insurers are playing games with patient care to juice their own bottom lines,” FAH President and CEO Chip Kahn said in a statement. “How many more examples does Congress need before they do something to hold managed care companies accountable for these outrageous practices that threaten patient care?” 
 
That release coincided with the news that another health system, the Minnesota-based Allina Health, may terminate contracts with certain MA plans. This follows other health systems who have done the same, including Essentia Health and Sanford Health. 
 
Home health providers have been considering the same. But, also, health systems exiting these relationships is likely a positive for home health organizations. If referral partners leave bad relationships with MA plans, home health providers can fulfill their duties to those partners without accepting poor payment from those plans for delivering services. 
“With the MA plans, it’s just becoming incredibly difficult,” Jeanne Byl, owner and COO of Interim HealthCare Great Lakes, told me last week. “And quite honestly, we’ve had to walk away.”
 
This week’s exclusive, members-only HHCN+ Update covers the trend that is health care providers – including home health providers – freeing themselves of burdensome MA plan relationships. 
 
When to walk away 
 
Interim HealthCare Great Lakes is a part of the overall Interim HealthCare brand, which consists of over 330 home care and home health locations across the U.S. 
As the name suggests, Interim HealthCare Great Lakes is a franchise group that mostly operates in the Midwest, but it also does business in Florida. 
 
As expressed before during these updates, home health providers have two core issues with MA plans. The plans don’t just pay less for services, they also require far more administrative burden. Claims are denied more, and prior authorizations are a pain. 
There is some positive momentum building around prior authorizations. A few forward-thinking health plans have worked to significantly reduce prior authorization requirements for providers and patients. 
 
Still, providers have these issues with the vast majority of payers they work with, and particularly the national plans. 
 
“We’re seeing greater barriers to care put in place by the insurers, and ultimately an increase in denials for care based on some random algorithm that says it isn’t necessary,” Preston Lucas, owner and CFO at Interim HealthCare Great Lakes, told me. “But if you really look at what’s clinically appropriate for that patient, it’s fully supported, and that’s a huge issue.”…

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