In this twice-monthly newsletter, you will find policy developments, research, and updates on how health care organizations are striving to shift more health care delivery into the home – meeting patient needs where they are and expanding access to quality health care.
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Congress: At the Last Minute, Congress Averted a Nearly 10% Cut to Medicare Providers, Including Home-Based Care Physicians (12/13) - Congress has acted to prevent the trio of Medicare payment cuts that were set to take effect at the beginning of 2022—a 3.75% cut due to scheduled changes in the Medicare Physician Fee Schedule (“PFS”), a 2% cut for Medicare sequestration, and a 4% Statutory Pay-As-You-Go (“PAYGO”) Act cut would have slashed Medicare payments by nearly 10%. The Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) was approved by the U.S. House of Representatives on December 7 and passed the U.S. Senate on December 9, 2021. It was then signed into law by President Biden.
The Act includes:
A one-year increase in the Medicare PFS of 3%;
A delay in resuming the 2% Medicare sequester for three months, followed by a reduction to 1% for three months; and
Erasing the 4% Medicare PAYGO cut, and preventing additional PAYGO cuts through 2022.
Senate Finance Committee: The Latest Text of the Build Back Better Act Released by the Senate Finance Committee Still Includes Permanent Extension of the Independence at Home Demonstration, With Technical Changes (12/11) - The most recent text of Build Back Better released by Senate Finance still includes a permanent extension of the CMS Innovation Center Independence at Home model, as well as funding to administer the program. The Independence at Home model, originally authorized in the Affordable Care Act, tests the effectiveness of delivering comprehensive primary care services at home and if doing so improves care for Medicare beneficiaries with multiple chronic conditions. The language did undergo technical changes, including new limits on the number of qualified medical practices participating under the demonstration based on phase-in beneficiary limits. The provisions begin on page 89 of the PDF linked above.
Medicare Payment Advisory Commission (MedPAC):Commissioners Question Home Health Access Data, Industry Turnover Rates (12/10) - The measurements used to track the home health industry could use some updating to better align perception with reality, according to MedPAC. And interestingly enough, access may be one of the rare occasions where on-the-ground evidence tells a truer story than available data. “The access to home health appears to be very good,” Evan Christman, a senior analyst for MedPAC, said during the commission’s public meeting Friday. “Eighty-eight percent of beneficiaries live in the counties served by five or more home health agencies. Ninety-nine percent of beneficiaries live in a county served by at least one home health agency.” In addition to access, MedPAC’s commissioners discussed home health agency margins, turnover rate, future payment recommendations and more.
Research and Polling
Journal of Clinical Nursing: Home-based nursing care competencies: A scoping review (12/12) - The objective of this study was to identify and consolidate the available evidence about nursing-related competencies for home-based care. Sixty-four articles were eligible for inclusion. Mapping and narrative synthesis of 116 elements related to home-based nursing care competencies identified 10 competencies. This review provides insight into current knowledge about home-based nursing care competencies. These competencies could be used to evaluate nurses’ competence level for home-based care or for the development of appropriate professional education. The review also outlines the scope of nursing practice in home-based care, which provides support for some form of standardization of home-based nursing care expectations across various stakeholders.
The American Journal of Managed Care: Potential Impact of Hospital at Home on Postoperative Readmissions (12/10) - Hospital at home (HAH) programs have been shown to offer a safe alternative to inpatient admission for select medical patients. This study is the first to estimate the potential impact of HAH as an alternative to postoperative readmissions. Of 2366 readmissions within 60 days of surgery at our institution, 731 readmissions met inclusion criteria for HAH (30.1%), representing 4152 bed days and a potential margin of $8.8 million. We believe our results will contribute to the expansion of HAH programs to include surgical patients, and we describe clinical/operational characteristics of our postoperative readmissions to aid in program development.
Avalere Health: Home Care Services Reduce Medicare Spending for 30 Chronic Conditions (12/8) - An Avalere analysis determined that Medicare Fee-for-Service (FFS) patients who received personal care services experienced a decrease in Medicare expenditures over time when compared to a statistically comparable control group comprising patients who did not receive the same level of personalized care. The reduction in spend was specific to a subset of chronic conditions that were targeted operationally for intervention and case management. This analysis was commissioned by MHH member, BrightStar Care. See the press release here.
NEJM Catalyst: Acute Hospital Care at Home: The CMS Waiver Experience (12/7) - When the Covid-19 epidemic intensified and hospitals were meeting or exceeding capacity, the U.S. Centers for Medicare & Medicaid Services (CMS) used its emergency authority to waive several regulations. The Acute Hospital Care at Home (AHCaH) initiative, launched in November 2020, allowed Medicare-certified hospitals to treat patients with inpatient-level care at home. Here, the authors describe a collaborative effort of CMS senior leadership and an AHCaH team of experts with decades of hospital-at-home experience that took the waiver from concept approval to publication in 8 days. As of October 27, 2021, 186 hospitals across 33 states have implemented AHCaH and have treated 1,878 patients. The small sample size limits the ability to draw clinical comparisons to non–public health emergency circumstances. Nonetheless, the AHCaH waiver initiative represents the first example of payment for this level of care for Medicare Fee-for-Service (FFS) and non-managed Medicaid beneficiaries.
HealthAffairs: Trends In Home Care Versus Nursing Home Workforce Sizes: Are States Converging Or Diverging Over Time? (December Issue) - There is strong preference among people with disabling conditions to receive care at home rather than in an institutional setting. Differences in state policies may make this more feasible in some states than others. Yet no study to date has examined trends in the long-term care workforce across states. Using state-level data on direct care workers from the period 2009–20, we examine trends in the sizes of the nursing home and home care workforces. We show that since 2009 most states have increased the size of their home care workforces and decreased the size of their nursing home workforces, but there is substantial variation across states in the magnitude of these changes. In addition, the gap between leading and lagging states in home care workforce size has grown over time. This suggests that more targeted efforts may be needed to ensure that people with disabling conditions can have their needs met in their desired setting across the nation.
News and Market Developments
PRNewswire: Rainbow Health Launches Technology Platform to Extend Services for Hospital-at-Home Programs (12/15) - Rainbow Health announced an extension of its platform Rainbow Care™ to encompass increased features for providers and health systems that offer hospital-at-home programs. The extended services will offer superior care coordination via Rainbow Health's platform and have been designed to address the logistical challenges that hospital-at-home programs are facing, while keeping an overall goal of supporting the operationalization and scalability of the programs.
Home Health Care News: Landmark Names Chris Johnson CEO, Looks to Double Patient Population (12/14) - Landmark Health is capping off 2021 with a new leader at its helm. The company named Chris Johnson CEO on Tuesday. Founded in 2014, the Huntington Beach, California-based Landmark is a multidisciplinary mobile medical group that delivers comprehensive in-home medical care to “the sickest and frailest” patient populations. The company – whose physician-led teams work alongside patients’ existing health care providers, including home health agencies – currently operates across 18 states. Johnson’s leadership as CEO will be integral to Landmark’s 2022 growth strategy, the company noted in a press release.
HealthcareDive: PharmAdva enhances Advanced Care at Home program by leveraging PharmAdva's MedaCube™ medication management solution (12/13) - PharmAdva, the manufacturer of comprehensive medication management and real-time data solution called the MedaCubeTM, has announced a collaboration with Mayo Clinic to enhance their Advanced Care at Home program that offers hospital-level care at home. The program is utilizing the MedaCube, an in-home medication management solution that meets the needs of patients with complex medical needs.
Health Payer Intelligence: The Impact of In-Home Chronic Disease Management on Spending (12/10) - Employing personalized, in-home chronic disease management services can have a significant impact on spending for seniors with chronic conditions, a study from Avalere found. “Demonstrating a positive impact on clinical and economic outcomes has been a long-standing challenge for the home care industry due to fragmented care standards across states, the lack of standardized measures in personal care, and limited access to claims data that would enable home health agencies that support patients with activities of daily living (e.g., medication management, meal preparation, patient education) to track and measure the impact of service delivery on patient utilization and outcomes,” the Avalere researchers began.
HealthcareITNews: Hospital at home: How healthcare organizations can set programs up for success (12/8) - Although telehealth is often thought of in the context of synchronous video visits, in reality, virtual care encompasses a wide range of opportunities to connect patients with medical care beyond brick-and-mortar facilities. One such expansion involves the provision of advanced care outside of in-person settings, sometimes known as "hospital at home." Several major healthcare organizations, including Kaiser and Mayo, have put forth efforts in this direction via advocacy and pilot programs. Other health systems, including Intermountain and Ascension, have made similar moves.
Home Health Care News: Aetna Medicare CMO Outlines Aging-in-Place Agenda (12/5) - America’s biggest health care companies continue to focus on home-based care and aging in place as 2022 approaches. That includes CVS Health Corporation (NYSE: CVS) subsidiary Aetna. Among its home- and community-based care initiatives, Aetna is doubling down on the use of telehealth and leaning into the CVS HealthHUB network, which offers seniors a range of services, from preventative care all the way to acute care. The insurer is likewise investing in “cost-effective care management programs” and expanding its relationships with home-centric partners like Papa and Contessa Health, according to Dr. Jamie Sharp, chief medical officer for Aetna Medicare. “We’re kind of assuming a new landscape for the delivery of health care and moving away from acute,” Sharp told Home Health Care News. “I think it’s important to focus on aging in place.”