Literature Review

CMMI’s proposed TEAM Model offers another risk-based opportunity for home health providers Home Helath Care News, by Andrew Donlan; 4/15/24Last 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.

Message-based telehealth an increasingly important part of seniors’ healthcare, study findsMcKnights Senior Living, by Aaron Dorman; 4/11/24 Many healthcare experts, and even government agencies, are working to try to expand telehealth coverage for older adults. But much of that work considers telehealth in terms of video and/or phone conversations. E-mails and digital messaging across patient portals, however, also are part of seniors’ healthcare regimen, particularly those who are Medicare beneficiaries, finds a new study published in Health Affairs Scholar. As such, updated telehealth coverage decisions should factor in the time that older adults, their caregivers and clinicians need to exchange these messages, the researchers said.

AHA seeks federal probe of MultiPlan, insurers Modern Healthcare, by Michael McAuliff; 4/9/24 The American Hospital Association wants the Labor Department to investigate the analytics company MultiPlan and its large insurer clients to determine whether they engage in business practices that disadvantage patients and providers. According to a New York Times investigation published Sunday, MultiPlan and customers such as UnitedHealth Group subsidiary UnitedHealthcare, CVS Health subsidiary Aetna and Cigna boost their finances by dispensing low payments to out-of-network providers and burdening patients with large bills.

Home Healthcare Market worth $383.0 billion by 2028 Iowanews Headlines; 4/11/24 [The] Home Healthcare Market in terms of revenue was estimated to be worth $250.0 billion in 2023 and is poised to reach $383.0 billion by 2028, growing at a CAGR of 8.9% from 2023 to 2028 according to a new report by MarketsandMarkets™. The primary drivers propelling the growth of this market are the aging population, rising healthcare expenditures, and the increased need for home care due to technological advancements in home healthcare.

How MA Plan design affects utilization, health equity MedCity News, by Marissa Pescia; 4/8/24 A new study found that enrollees with zero-premium MA plans are three times as likely to be non-White compared to other MA enrollees and traditional Medicare enrollees. ... The study was published by Harvard Medical School and Inovalon, a provider of cloud-based software solutions. It used Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry dataset, which “tracks demographic characteristics and outcomes for about 30% of all MA members at any given point in time,” according to the report.

Insurers’ response to the Change breach failed providers Modern Healthcare, by Chip Kahn and Dr. Bruce Siegel; 4/8/24 ... The Feb. 21 attack on Change Healthcare, a subsidiary of UnitedHealth Group’s Optum unit, severed the electronic ties that connect patients, providers and insurance companies. The attack robbed patients of the certainty they could seek and receive care, and it robbed physicians, pharmacists and hospitals of the resources necessary for patient care. ... Overlooked in this crisis, is that insurance companies failed to act decisively and collectively to protect patients and providers. ... Here’s what should have happened immediately when the threat facing patient care became painfully obvious. 

Navigating new requirements in the 2025 proposed Hospice Rule Hospice News, by Jim Parker; 3/5/24 If the U.S. Centers for Medicare and Medicaid Services’ (CMS) proposed 2025 hospice rule is finalized as written, hospices may encounter some hurdles implementing some of the new requirements. MS late last month issued its proposed hospice rule for 2025. The proposal called for a 2.6% increase in hospice per diem base rates, a number that many stakeholders say is insufficient in today’s economic climate.

USDA Rural Development accepting applications for grants to fund high-speed Internet and digital equipment for rural and tribal communitiesU.S. Department of Agriculture Rural Development, by Leigh Hallet; 4/4/24The U.S. Department of Agriculture (USDA) Rural Development invites grant applications for two programs that fund broadband access. The Distance Learning and Telemedicine (DLT) Grant Program helps organizations provide online training, education, and health services. It funds services, training, and equipment to digitally connect people to education, training, and health care resources.

Proposed hospice rule offers key quality improvement changes, experts offer McKnights Home Care, by Adam Healy; 4/4/24While the recently proposed 2025 hospice payment update included a payment adjustment that stakeholders have perceived as inadequate, it also introduced valuable new tools to address hospice quality and more, according to industry regulatory experts. One of the proposed rule’s most enticing features is the Hospice Outcomes and Patient Evaluation (HOPE) tool, which next year will replace the current Hospice Item Set (HIS) measurement system used by the Centers for Medicare & Medicaid Services to track hospice quality.

What home health providers need to know about the Medicare TPE Audit ProcessHome Health Care News, by Joyce Famakinwa;  4/2/24... TPE is a medical review program that began for the home health and hospice settings in December 2017. The goal of the program is to weed out improper payments by zeroing-in on providers with high claims denial rates or unusual billing practices. ... TPE has three pillars. Target refers to errors or mistakes that are identified through data in comparison to providers or peers. Probe is the examination of 20 to 40 claims. ... Education means helping providers reduce claim denials and appeals through one-on-one individualized education.

CMS finalizes 2025 Medicare Advantage rates Becker's Payer Issues, by Rylee Wilson; 4/1/24 CMS finalized a slight decrease in Medicare Advantage benchmark payments for 2025. The agency published its final rate notice for 2025 April 1. The final rule was largely similar to CMS' proposed payment rates issued in January. The agency will cut benchmark payments by 0.16% from 2024 to 2025. CMS estimated plans will see 3.7% higher revenue overall in 2025. MA risk score trend of 3.86% — the average increase in risk adjustment payments year over year — will offset risk model revisions that will lead to a 2.45% decline in revenue and a projected decline in star rating bonuses, according to the agency. 

CMS releases Hospice Payment rate update proposed rule [Industry voices] HomeCare News; 3/29/24... "While the proposed rule may appear to be fairly innocuous," said NAHC President William A. Dombi, in response to the rule announcement, "the hospice community should pay attention to the information request on high cost services as it may signal an emerging interest in payment model reform. What is missing is also notable, CMS has not proposed any program integrity measures to address continued concerns on the surge in hospice growth in certain parts of the country despite the warning signs presented." ...Editor's Note: Additional responses from "industry voices" include NACH Vice President Davis Baird; NAHC's Director of Home Health and Hospice Regulatory Affairs Katie Wehri; and CEO Leading Age Katie Smith Sloan.

[UPDATED] CMS 2025 proposed rule signals changes to quality measurement, omits program integrity actionsHospice News, by Jim Parker; 3/29/24In a proposed rule released [Thursday], the U.S. Centers for Medicare & Medicaid Services (CMS) proposed a 2.6% increase in hospice per diems for 2025. The agency also proposed two new quality measures and 2025 implementation of the Hospice Outcome and Patient Evaluation (HOPE) assessment tool to replace the Hospice Item Set.However, stakeholders in the hospice space contend that the increase is insufficient in light of continued inflation, interest rates, staffing shortages and wage hikes.