Literature Review

What home health providers need to know about CMS’ Medicare enrollment changesHome Health Care News, by Patrick Filbin; 1/31/24The Medicare enrollment process undergoes annual changes at the Centers for Medicare & Medicaid Services (CMS) to ensure it remains up to date with evolving regulations, policies and health care practices. A number of changes went into effect on Jan. 1, and several of them will affect home health agencies. Here’s what home health agencies should know about those changes.

Centers for Medicare & Medicaid Services issues rule: Medicare Program; Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System rate update; HH Quality Reporting Program requirements; HH ...Department of Health and Human Services, by Centers for Medicare & Medicaid Services; 1/31/24SUMMARY: This document corrects technical errors in the final rule that appeared in the November 13, 2023 Federal Register titled "Medicare Program; Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin Items and Services; Hospice Informal Dispute Resolution and Special Focus Program Requirements, Certain Requirements for Durable Medical Equipment Prosthetics and Orthotics Supplies; and Provider and Supplier Enrollment Requirements'' (referred to hereafter as the "CY 2024 HH PPS final rule"). Effective date: This correcting document is effective January 31, 2024

Video raises concerns about a father’s final days in senior care homeThe Atlanta-Journal Constitution Online, by Allie Gross; 1/30/24A 78-year-old veteran's final days at a Georgia senior care home, Savannah Court of Lake Oconee, raise troubling questions about care at the facility and the state's oversight. The new concerns come as the facility faces possible closure with a second license revocation hearing scheduled for Jan. 30, 2024.

Has Medicare Advantage lost its luster?Becker's Payer Issues, by Rylee Wilson; 1/29/24Though Medicare Advantage enrollment keeps climbing, the program may not have the profitability it once did for insurers. In a January analysis shared with Becker's, Moody's analysts wrote that the program "seems to be losing some of its luster," facing a significant increase in medical costs and lower reimbursement rates from CMS. Earnings in Medicare Advantage shrunk by 2.1% among the insurers Moody's rated from 2019 to 2022, despite premiums and members growing by 40% in the same time period.

Viewpoint: Care fragmentation, care continuity, and care coordination—How they differ and why it mattersJAMA Intern Med., by Lisa M. Kern, MD, MPH; Julie P. W. Bynum, MD, MPH; Harold Alan Pincus, MD; 1/29/24Health care in the US is characterized by fragmentation, with many patients seeing multiple physicians. Indeed, 35% of Medicare beneficiaries saw 5 or more physicians in 2019.1 Having multiple physicians may be appropriate, but it may also lead to medical errors, unnecessary visits, avoidable hospitalizations, and suboptimal care if all of the physicians do not have complete information about the patient and each other’s care plans.

Medicare and Medicaid programs; Quarterly listing of program issuances-October through December 2023 Federal Register, "A Notice by the Centers for Medicare & Medicaid Services"; 1/30/24  This quarterly notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published in the 3-month period, relating to the Medicare and Medicaid programs and other programs administered by CMS. 

Changing payment dynamics are forcing home-based care providers to level up in value-based careHome Health Care News, by Patrick Filbin; 1/24/24When home-based care professionals were tasked with providing the “greatest challenge” facing them in the new year, 58% responded staffing. After that, 31% said changing payment dynamics, while 7% and 4% said consolidation or non-payment regulatory changes, respectively. Those findings come from a recent survey conducted by Home Health Care News and Homecare Homebase.

A study of how Americans die may improve their end of lifeMedical Xpress, by Rutgers University; 1/24/24A Rutgers Health analysis of millions of Medicare records has laid the groundwork for improving end-of-life care by demonstrating that nearly all older Americans follow one of nine trajectories in their last three years of life.

Hospice providers must be better regulatedScientific American, 2/1/24 (also ran last week)Too many hospice providers in the U.S. are run by private equity and for-profit corporations. A lack of regulation allows them to provide abysmal end-of-life care.

CMS Strategic Plan [last modified 1/23/24]CMS.gov; 1/23/24[Includes CMS Strategic Pillars; CMS Accomplishments for 2022; 2023 CMS Strategic Framework; Cross-Cutting Initiatives; more]

$15 billion win for physicians on prior authorizationAMA, by Kevin B. O'Reilly; 1/18/24Under the leadership of Administrator Chiquita Brooks-LaSure, the Centers for Medicare & Medicaid Services (CMS) has released a final rule making important reforms to prior authorization to cut patient care delays and electronically streamline the process for physicians. Together, the changes will save physician practices an estimated $15 billion over 10 years, according to the U.S. Department of Health and Human Services (HHS).

US Senate launches investigation of assisted living after lay media reports about safety, staffing, pricingMcKnight's Senior Living, by Kimberly Bonvissuto; 1/17/24The US Senate Special Committee on Aging is launching a review of the assisted living industry following recent articles in the Washington Post, which reported on the deaths of residents who wandered from communities, as well as the New York Times and KFF, which scrutinized an industry pricing structure that adds fees on top of basic charges to cover additional services, as well as rate increases and the for-profit status of most providers.

MedPAC approves hospital, physician pay bump; Doubles down on post-acute cutsInsideHealth Policy, by Bridget Early; 1/12/24Congress’ Medicare pay advisors recommended pay raises in 2025 for hospitals and physicians along with extra so-called Medicare safety-net pay and voted Thursday ... to recommend a second year’s worth of post-acute pay cuts as it approved proposals that would lower base pay rates for skilled nursing facilities, home health agencies and inpatient rehabilitation facilities.