In The News

CMMI’s Proposed TEAM Model Offers Another Risk-Based Opportunity For Home Health Providers

Home Health Care News By Andrew Donlan
 
Last week, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new proposed model that will undoubtedly affect home health providers, and also allow them the opportunity to get more involved in value-based care initiatives. 
 
The Transforming Episode Accountability Model (TEAM), which would eventually be mandatory if finalized, would have selected acute care hospitals put under full responsibility for the cost – and quality – of care from surgery up until the first 30 days after hospital discharge. 
 
CMS said that the model would build on the already existing Bundled Payments for Care Improvement Advanced (BPCI-A) and Comprehensive Care for Joint Replacement models. The proposed model would launch on Jan. 1, 2026, and run for five years, ending at the end of 2030. 
 
“TEAM would be a mandatory episode-based alternative payment model in which selected acute care hospitals would coordinate care for people with Traditional Medicare who undergo one of the surgical procedures included in the model (initiate an episode) and assume responsibility for the cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital,” CMS wrote. “As part of taking responsibility for cost and quality during the episode, hospitals would connect patients to primary care services to help establish accountable care relationships and support optimal, long-term health outcomes.”
 
Given those all-important 30 days post discharge involved in the TEAM model, home health providers will naturally play a role in helping hospitals achieve high-quality outcomes. 

The National Association for Home Care & Hospice (NAHC) is still awaiting further details, but sees home health agencies as squarely involved in the Innovation Center’s proposal. 

“Much of the specifics are still to be decided,” NAHC President William A. Dombi told Home Health Care News. “Home health agencies can be expected to be significantly involved with the participating hospitals given the nature of the surgical patients that will be targeted, such as hip fractures and joint replacement patients.”…

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Stateline Operations Manual (SOM) Appendix B

NAHC

CMS has issued the online (final) version of the State Operations Manual (SOM) Appendix B – Home Health Agencies (Interpretive Guidelines). A few revisions had been made from the Advanced copy of the Appendix B that was issued on March 15, 2024.  

  • Revised criteria for citations related to the Error Summary Report for late OASIS submissions.
    • If an HHA shows a pattern of multiple assessments with error -3330 on this report, surveyors should investigate compliance with G372, Encoding and transmitting OASIS data (§484.45(a)).
  • Corrected the statement in §484.45(a) to read: The OASIS reporting regulations are not applicable to patients receiving personal care only services, regardless of payor source.
  • Removed reference to the OASIS guidance for §484.55(a)(1) and (d)(3)

NAHC will continue to review the revised Appendix B for any other changes and will update the NAHC 2024 Revised IG Chart.

 

Home Healthcare for Elderly Sees Largest Price Increase Ever

The Hill - Changing America / By Alejandra O’Connell-Domenech

Costs for home healthcare for the elderly and bed-ridden have gone up by 14.2 percent over the past year, according to new Consumer Price Index data released Wednesday.  
 
That represents the largest percent increase in home healthcare costs during a 12-month period since the Bureau of Labor Statistics began collecting data on such costs in 2005.  

The United States has an aging population, and the need for care among the nation’s roughly 73 million Baby Boomers is driving up the cost of nursing homes, assisted living facilities and home healthcare.  
 
About 70 percent of American adults aged 65 and older will need some form of long-term care in the future, according to the Administration for Community Living.
 
There are two main types of in-home care providers for the elderly or bed-bound: home health aides who help with personal care and homemaker aides who assist with household chores.  
 
The prices for these aides’ services vary by need and location, but in 2023 the median cost for a home health aide was $33 an hour and that for a homemaker aide was $30 an hour, according to insurance company Genworth.  
 
The reason behind the striking increase in in-home care costs stems from shortages in the country’s home health workforce coupled with rising wages for these workers, according to Marc Cohen, co-director for the Leading Age Long Term Services and Supports Center at the University of Massachusetts-Boston.  
 
In 2022, there were about 4.8 million direct care workers, a category that include home health aides, according to an analysis from KFF. These workers helped 9.8 million people at home, 1.2 million in residential care facilities and 1.2 million in nursing homes.
 
The direct care sector is expected to add over 1 million new jobs by 2031, according to that same analysis. But those additional jobs will not be enough to meet the country’s rising eldercare needs.  

 

How Home Health Providers Can Avoid Payment Denials

Home Health Care News / By Joyce Famakinwa

Payment denials can be costly and time consuming for home health providers, and they’re often self-inflicted. 
 
In order to avoid this all together, home health leaders should educate themselves on the common reasons behind denials, and also adopt documentation techniques that will help their organizations stay compliant with Medicare’s coverage criteria.
 
That was the main takeaway of a recent webinar hosted by WellSky, an Overland Park, Kansas-based company that utilizes software and analytics to help providers across the continuum achieve better outcomes at lower costs.
 
One of the most prevalent claims errors is not including the signature of a certifying physician. Documentation not meeting medical necessity is another top claims error that providers make. 
 
Other common claims errors include encounter notes that don’t support all elements of eligibility, and missing or incomplete certifications or recertification documents.
 
“If you get a SMRC, or a supplemental Medical Review contractor, request for additional information, and you don’t comply … they will notify your Medicare Administrative Contractor. That can initiate claim adjustments and/or overpayment recoupment actions through their standard recovery process,” Beth Noyce, of Noyce Consulting, said during the webinar presentation. 
 
Providers are able to appeal, but this can be a lengthy and cumbersome process.
Noyce noted that providers looking to find the home health coverage and documentation requirements, in order to stay on the right side of compliance rules, should be aware that all of the information is available to the public.
 
“All of the things are published, everything’s available to you without having to spend a dime of extra money, and it’s all in the public domain,” she said. 

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One-Minute Speech Test Could Help Assess Dementia Risk

Medscape / By Sara Freeman

BUDAPEST — Analyzing temporal changes in people's speech could be a simple way of detecting mild cognitive impairment to see whether there is a risk of developing dementia in the future, suggests research.

János Kálmán, MD, PhD, and colleagues at the University of Szeged in Hungary have developed an automated speech analysis approach called the Speech-Gap Test (S-GAP Test) that is unique because it focuses on the temporal changes made when someone talks. This means it does not overcomplicate matters by also assessing the phonetics and semantics of speech, Kálmán told Medscape Medical News. 

Kálmán presented his findings at the 32nd European Congress of Psychiatry. 

Temporal Speech Parameters

The test analyzes parameters such as how quickly someone speaks, whether they hesitate when they talk, how long the hesitation lasts, and how many silent pauses they make. This can be done with a mere 60-second sample of speech, Kálmán said, noting that other automated speech and language tools currently in development need much longer audio samples. 

"We tried different approaches and we finally ended up with the temporal speech parameters because these are not culture-dependent, not education-dependent, and could be more reliable than the semantic parts of [speech] analysis," he explained.

The analysis of temporal speech parameters is also not language-dependent. Although the S-GAP Test was developed using audio samples from native Hungarian speakers, Kálmán and his collaborators have shown that it works just as well with samples from native English and German speakers. They now plan to validate the test further using samples from native Spanish speakers. 

For Screening, Not Diagnosis

Currently, "the only purpose of this tool would be initial screening," Kálmán said at the congress. It is not for diagnosis, and there is no intention to get it registered as a medical device. 

A national survey of primary care physicians conducted by Kálmán and collaborators showed that there was little time for performing standard cognitive tests during the average consultation. Thus, the original idea was that the S-GAP Test would be an aid to help primary care physicians quickly flag whether a patient might have cognitive problems that needed further assessment at a memory clinic or by more specialist neurology services. 

The goalposts have since been moved, from developing a pure telemedicine solution to a more widespread application that perhaps anyone could buy and download from the internet or using a smartphone. 

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