Literature Review

Providers meet with OMB to prevent ‘devastating’ effect of 80/20 provision McKnights Home Care, by Adam Healy; 3/4/24Home care stakeholders have been busy on Capitol Hill voicing concerns about a controversial provision of the proposed Medicaid Access Rule. The National Association for Home Care & Hospice and Home Care Association of America met with the Office of Management and Budget last week to discuss the Access Rule’s so-called 80/20 provision. The provision, if finalized, would require that 80% of Medicaid payments for personal care, home health and homemaker services be spent on workers’ compensation. “If that one provision is finalized as proposed, it would be so detrimental that we’d likely lose a significant portion of our service delivery base and people would go without care,” Damon Terzaghi, NAHC’s director of Medicaid HCBS (home- and community-based services) said in an interview with McKnight’s Home Care Daily Pulse. “It would truly be devastating.”

[Updated] CMS crackdown on fraudulent hospice providers in full effect in 2024, expert says McKnights Product Theater, by Adam Healy; 2/22/24In recent years, unscrupulous hospice providers have cropped up in California and other states. In response, the Centers for Medicare & Medicaid Services has prepared a slew of tools to curtail the fraud. States continue to feel the effects. As an example, a California hospice operator last week was convicted in a Medicare fraud scheme for billing nearly $3 million for services that patients did not need, according to the Department of Justice. 

How one hospice owner got convicted of healthcare fraud and how you can avoid that fateHospice Insights: The Law and Beyond, by Husch Blackwell; 2/21/24The owner of a Louisiana hospice was indicted and then convicted of healthcare fraud. How did that happen? In this [podcast] episode, Husch Blackwell's Meg Pekarske and Jonathan Porter talk about how a routine audit led to a whistleblower complaint by a hospice employee, which then led to the hospice owner’s criminal conviction following trial in November 2023. Most importantly, the pair discuss how other hospices can avoid that fate.

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. 

NC Medicaid rolls grow by 1,000 people a day as smooth expansion rollout continues its third monthNC Health News, by Jamie Baxley; 2/15/24When North Carolina launched Medicaid expansion on Dec. 1, state officials said the measure would provide health insurance to an estimated 600,000 low-income adults over a span of two years. It took just two months to reach 58 percent of that goal. More than 346,400 newly eligible beneficiaries have been approved for coverage as of Feb. 1, according to data from the N.C. Department of Health and Human Services.

Part 2, Latest updates from CMS Office of Minority Health: Advancing health equity in rural, tribal, and geographically isolated communities FY2023 year in review

Concurrent Medicare hospice & curative care improves quality & reduces costs 13%Open Minds; 2/7/24Medicare beneficiaries with terminal health conditions who participated in the Medicare Care Choices Model (MCCM), received high quality care at a 13% lower cost compared to similar beneficiaries who did not receive the MCCM services. The Centers for Medicare & Medicaid Services (CMS) tested this new model as an option for Medicare beneficiaries to receive supportive care services while continuing to receive services for their terminal condition.

Patient-centered focus is key to reducing hospitalizations, value-based success, experts sayMcKnights Home Care, by Adam Healy; 2/6/24To keep hospitalization rates low — and thereby produce better results within the Home Health Value-Based Purchasing (HHVBP) model — providers need a good understanding of patients’ goals to tailor care to meet their unique wants and needs. ... Keeping these goals at the forefront of care can reduce their chances of being hospitalized, according to Cindy Campbell, senior director of advisory services at healthcare technology firm WellSky. But defining patients’ goals is not just a recommendation, she noted: It’s mandated by the Centers for Medicare & Medicaid Services.

Cancer facts & figures 2024American Cancer Society; 2024Cancer Facts & Figures 2024 is an educational companion for Cancer Statistics 2024, a scientific paper published in the American Cancer Society journal, CA: A Cancer Journal for Clinicians. These annual reports provide:

Facing the future: Home health providers gear up for 2024’s value-based care, M&A landscapesHome Health Care, by Andrew Donlan; 2/1/24Home-based care providers have faced many headwinds over the past few years. They’ll continue to do so in 2024. But uncertainty has also plagued providers, and there may be less of that this year. Providers know the threat of fee-for-service Medicare cuts. They know Medicare Advantage (MA) penetration is an unstoppable force. They know staffing woes will be a mainstay, even if the labor market nominally improves.

Hospice and home health survey perspectives: A conversation with Kim Skehan, VP of Accreditation at CHAPHospice Insights: The Law and Beyond, podcast by Meg Pekarske; 1/31/24In this episode, Husch Blackwell’s Meg Pekarske is joined by friend and industry veteran Kim Skehan. In this wide-ranging conversation, they explore not only the recent survey reforms but the ways in which Kim’s decades of work as a survey consultant to hospices and home health agencies shape how she approaches her new role leading accreditation at CHAP.

Docs see smaller checks as Congress weighs options on Medicare cutModern Healthcare, by Michael Mcauliff; 1/30/24If anyone were to ask members of Congress if doctors should be contending with Medicare pay cuts after a pandemic and a period of extraordinary inflation, and amid a chronic physician shortage, nearly all would say no.Subscription required for full access

Hospice fraud back in the spotlight, with new data also raising questions about home health careHome Health Care News, by Robert Holly; 1/30/24The number of hospice providers enrolled in the Medicare program in four states has skyrocketed over the past few years. The jaw-dropping spike, in turn, has triggered increased oversight efforts – some of which may not be having the desired effect. A similar trend could be happening in home health care in one major county, U.S. Centers for Medicare & Medicaid Services (CMS) data suggests. In hospice, the surge of new providers and potentially fraudulent activities has been concentrated in Arizona, California, Nevada and Texas. In home health care, it’s Los Angeles County.