Literature Review

‘Playbook’ offers strategies for home health, hospice firms to jump into value-based care McKnights Home Care, by Adam Healy; 2/28/24 Don’t drag your feet. As entities like Medicare Advantage and Accountable Care Organizations continue to grow and thrive, the time is now for home care to step into value-based care, according to home care consultants at Transcend Strategy Group. “The next two or three years are going to be very critical,” Tony Kudner, chief strategy officer at healthcare consultancy firm Transcend Strategy Group, said in an interview Tuesday with McKnight’s Home Care Daily Pulse. “Now is the time to build out the larger organizational competencies that value-based care is going to require.”

CMS upends Medicare Advantage supplemental benefits data reporting for payers DLA Piper, by Daivd Kopans and Sua Yoon; 2/27/24 On February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) issued new guidance via a memorandum to Medicare Advantage (MA) organizations, Program of All-Inclusive Care for the Elderly (PACE) organizations, and Demonstration Organizations (collectively, Plans) that upends how these Plans have been reporting (or not reporting) encounter information for their covered supplemental benefits. The guidance in the memorandum is effective retroactively to January 1, 2024. [In this article] is a Q&A explaining the top points of the guidance and highlight its impact on companies across industries.

Why not-for-profit health systems need positive margins: Deloitte Becker's Hospital CFO, by Andrew Cass; 2/28/24Health system margins are the "lifeblood of a healthy, patient-centered, innovative health care system and community," according to a report from consulting firm Deloitte.  "Claims that profits are not important in fact undermine the ability to fund the mission, serve the community, and deliver better, equitable care," Deloitte said in the report. ... "[Systems] should consider a holistic approach that integrates margin drivers to create a balanced transformation portfolio, according to the report. Timing and sequencing are important within each driver and "a full understanding of the dollar impact and priority of each is necessary for margin improvement to be successful."

CMS finalizes important changes to Medicare enrollment requirements for hospice, home health providersJDSupra; 2/28/24The US Centers for Medicare & Medicaid Services (CMS) finalized important changes to the Medicare enrollment regulations applicable to hospices and home health agencies (HHAs), including increasing the level of screening that hospice providers are subject to and limiting a Medicare-enrolled hospice’s ability to change majority ownership to once every 36 months.

Where hospices are investing their 2024 recruitment, retention dollars Hospice News, by Holly Vossel; 2/20/24As hospices zero in on their investments in staff engagement and operational efficiencies, organizational culture is becoming a higher priority. ... Some have leveraged technology to streamline their operations and reduce documentation burdens, while others have poured resources into sculpting their organizational culture and developing training and career pathways.Notable mentions: Tanya Marion, Enhabit; Craig Dresang, YoloCares; Cooper Linton, Duke HomeCare & Hospice.

Providers urge CMS to use caution in midst of hospice VBID implementationMcKnights Home Care, by Adam Healy; 2/23/24With the Medicare Advantage Value-Based Insurance Design (MA VBID) model, which allows MA organizations to participate in the hospice benefit, underway, advocates have voiced concerns that critical safeguards be put in place.

The bottom line: Top billing, financial mistakes responsible for home health agency struggles

Reduced federal share may force state Medicaid programs to cut services, HCBS expert saysMcKnights Home Care, by Adam Healy; 2/15/24The Congressional Budget Office this month released its “Budget and Economic Outlook” report for the coming decade. In its report, CBO predicted a roughly $58 billion drop in federal Medicaid outlays for 2024 compared to 2023 — a 9% decrease in federal Medicaid spending, due in part to fewer beneficiaries on states’ Medicaid rolls. Reduced Medicaid outlays ... has placed an even greater strain on states to pay for these Medicaid programs, according to Damon Terzaghi, director of Medicaid HCBS for the National Association for Home Care & Hospice.

CMS issues additional guidance on program to allow people with Medicare to pay out-of-pocket prescription drug costs in monthly paymentsCMS.gov; 2/15/24The Inflation Reduction Act’s Medicare Prescription Payment Plan will allow people to pay Medicare Part D out-of-pocket costs over the course of the year starting in 2025. [On February 15th,] the Centers for Medicare & Medicaid Services (CMS) released the second part of draft guidance for the Medicare Prescription Payment Plan that outlines requirements for Medicare Part D plan sponsors, including outreach and education requirements, pharmacy processes, and operational considerations, for the program’s first year, 2025. 

Medicare Advantage profitability on the decline, Moody's findsHealthcare Finance, by Jeff Lagasse; 2/2/24A significant spike in utilization is putting cost pressure on insureres, which will likely affect earnings. While Medicare Advantage remains attractive to the healthcare industry due to strong growth, high revenue and earnings per member, profitability is on the decline, according to a new analysis by Moody's Investor Service.

Lee County belt tightening means a reduction in hospice careWIUM Trstates Public Radio, by Will Buss; 2/1/24Lee County Supervisors are looking for ways to reduce spending. As a result, the health department is scaling back the level of hospice care it provides terminally ill residents. Administrator Michele Ross said the department has pushed to retain hospice service but will refer more residents to private providers.

How hospices are diversifying their services in 2024Hospice News, by Holly Vossel; 1/31/24Palliative care, pediatric end-of-life care and end-of-life doula (EOLD) services are top of mind for hospices that are diversifying their services in 2024.Fewer than half of 143 respondents to Hospice News’ 2024 Outlook Survey, conducted with Homecare Homebase, reported that their hospice organizations would pursue new care types this year. But the aim of their service diversification efforts may indicate future trends. Service diversification trends in hospice could ramp up as value-based care models incentivize this path, according to Tony Kudner, chief strategy officer of the home-based care consulting company Transcend Strategy Group. 

As denials climb, MACPAC approves recommendations for managed care oversight McKnights Home Care, by Adam Healy; 1/29/24The Medicaid and CHIP Payment Advisory Commission on Friday approved seven recommendations to enhance congressional oversight of Medicaid managed care organizations as recent reports reveal startlingly high rates of prior authorization denials.