Literature Review

MedPAC draws fire with draft recommendations for massive home health cut, hospice rate freezeMcKnight’s Home Care DailyDecember 12, 2023The Medicare Payment Advisory Commission offered initial recommendations for Congress to cut home health reimbursement by 7% and pause hospice payment updates in 2025. “The 2022 [home health] margins remain above 20%, higher than the long-run average of 16.8% since 2001,” Evan Christman, senior analyst at MedPAC, said during last Friday’s public meeting, according to a transcript. “Overall, these margins indicate that Medicare fee-for-service continues to pay well in excess of cost.” Part of the reason home health agencies reportedly saw margins of 22.2%, on average, according to Christman, is a decline in the number of visits per 30-day period. Since the implementation of the Patient-Driven Groupings Model in 2020, these visits have declined more than 15%; between 2021 and 2022, visits per 30 days declined 3.5%. Home health advocates were quick to dispute MedPAC’s claims. “There are many shortfalls in MedPAC’s home health margins report—starting with the fact that MedPAC’s analysis only captures a declining fraction of the Medicare home health population, ignoring that overall margins are low,” Joanne Cunningham, chief executive officer of the Partnership for Quality Home Healthcare, said in a statement. ... The Partnership and National Association for Home Care & Hospice cited poor methodology and data in the recent home health final rule, which contained a Medicare cut related to PDGM. MedPAC also recommended that Congress eliminate any payment updates for hospice providers in 2025. 

Forced to work in a vacuum, MedPAC recommends another Medicare cutMcKnight’s Long Term Care NewsDecember 11, 2023A Congressional advisory group appears ready to recommend a 3% Medicare pay cut for nursing homes in 2025. In what has become an annual tradition, members of the Medicare Payment Advisory Commission voiced ongoing concerns Friday about the use of Medicare Fee for Service reimbursement to effectively subsidize Medicaid rates and Medicare Advantage payments. With official data indicating that patients still have plenty of access to care, panel staff recommended MedPAC tell Congress that it should pursue a cut to Chair Michael Chernew, PhD, a healthcare policy professor at Harvard, said the 3% cut could be steeper given the reported margins. But the commission—tasked only with considering Medicare policy—remains cognizant of the pressures faced by providers accepting Medicaid and being increasingly low balled by managed care plans.

Palliative Care News’ Top 5 Stories of 2023Palliative Care NewsDecember 6, 2023A look back at Palliative Care News’ five most-read stories this year paints a picture of trends shaping the serious illness care space. Securing reimbursement—and the promise of value-based contracts—continues to be top of mind for many palliative care providers as they look ahead to 2024. Operators have their eyes on the ever-shifting payment landscape and the headwinds and opportunities that come with it. Meanwhile, more providers are increasingly working to address health disparities among underserved populations in various settings, including prisons and rural areas, among others. But in the midst of this, workforce shortages and clinical capacity issues remain obstacles to palliative care access. The following are the most-read Palliative Care News articles of 2023.

Patient-centered medical homes can reduce care cost of chronically ill patients, study findsMcKnight’s Home Care DailyDecember 5, 2023High-cost patients receiving care through patient-centered medical home programs are less likely to remain high-cost in the long term, according to a recent study published in the American Journal of Managed Care. ... The researchers compared the healthcare expenditures and health outcomes of thousands of PCMH and non-PCMH patients across Maryland during the state’s Multi-Payer PCMH program. They found that high-cost patients, such as those with chronic conditions, frailty or greater rates of hospital or ambulance usage, experienced better health outcomes with less health service utilization.