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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Moving Health Home News
Moving Health Home: Response to the Congressional Request for Information on Medicare Payment System (10/31) - Moving Health Home (MHH) responded to the congressional request for information on Medicare Payment System. Specifically, MHH expressed the value of the home as the future of care delivery, which has been revitalized by growth in value-based care and alternative payment models. When models of care make the provider accountable for the quality and total cost of care, we see more care delivered in the home and community because providers understand that it is the better site of care for the patient. MHH asked Congress to seek new opportunities to drive more value-based care to better enable in-home care as part of the next steps of their legislative workstream.
National Home Infusion Association: Patient Stakeholder Groups Urge Congress to Address Medicare's Failed Home Infusion Benefit (10/31) - A diverse group of 30 patient and stakeholder groups, including Moving Health Home, sent a letter urging Congress to address Medicare beneficiary access to home infusion services. The letter goes on to cite a report released by the Centers for Medicare and Medicaid Services (CMS) in January 2022 confirming that utilization of the benefit has been low.
CMS: Calendar Year (CY) 2023 Physician Fee Schedule Final Rule (11/1) - CMS released the final CY 2023 Physician Fee Schedule rule, which makes payment and policy changes under Medicare Part B effective on or after January 1, 2023. CMS finalized significant changes to the Medicare Shared Savings Program; expands access to and coverage of behavioral health services; makes additional adjustments to evaluation and management visit codes and documentation; extended payment for telehealth services for 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022; and promotes health equity, among other proposals. Specifically, CMS finalized the RUC-recommended work RVU for all eight CPT codes in the Home or Residence Services CPT code family and the continuation of the in-home additional payment for administering COVID-19 vaccines for CY 2023.
CMS: Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule with Comment Period (CMS 1772-FC) (11/1) - CMS finalized the Medicare payment rates for hospital outpatient and ambulatory surgical center (ASC) services. CMS finalized their proposal to consider behavioral health services furnished remotely by clinical staff of hospital outpatient departments, including staff of critical access hospitals (CAHs), through the use of telecommunications technology to beneficiaries in their homes, covered outpatient services for which payment is made under the OPPS.
CMS: CY 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements — Final Rule (CMS-1766-F) (10/31) - CMS issued the calendar year (CY) 2023 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates Medicare payment policies and rates for home health agencies (HHAs). This rule includes routine updates to the Medicare Home Health PPS and the home infusion therapy services’ payment rates for CY 2023, in accordance with existing statutory and regulatory requirements. CMS estimates that Medicare payments to HHAs in CY 2023 will increase in the aggregate by 0.7 percent, or $125 million compared to CY 2022.
CMS: Calendar Year 2023 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule (CMS-1768-F) (10/31) - CMS issued a final rule updating payment rates and policies under the end-stage renal disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2023. The final rule summarizes the comments CMS received in response to an RFI on potential indicators of quality for patients who receive dialysis at home in order to support the use of home dialysis for ESRD patients where it is appropriate. Additionally, the final rule adjusts the Home Dialysis Payment Adjustment (HDPA) in the ESRD Treatment Choices (ETC) Model. The Home Dialysis Payment Adjustment (HDPA) is an upward adjustment on home dialysis and home dialysis-related claims with claim service dates between January 1, 2021 and December 31, 2023, the initial three years of the ETC Model.
CMS: TennCare III Amendment (10/27) - CMS announced that Tennessee submitted an amendment to the TennCare III demonstration proposing to continue to provide the enhanced home and community-based services (HCBS) supports beyond the expiration of the public health emergency (PHE).
Research and Polling
American Journal of Health-System Pharmacy: A hospital at home case report: Prolonged amphotericin B therapy via elastomeric pump (11/2) - Hospital at home is a unique care model that allows patients to receive inpatient hospital care within the comfort of their home and can be seen as an alternative care site for patients with complex treatment regimens that may require prolonged hospitalization. Hospital systems have increasingly begun incorporating hospital at home programs into their inpatient service lines. We present the case of a patient with disseminated histoplasmosis requiring a prolonged course of intravenous liposomal amphotericin B therapy. Because of the complex administration and stability of this medication, care is often provided in an inpatient setting. The Vanderbilt University Medical Center Hospital at Home team was able to coordinate resources and services to allow for this patient to receive acute hospital care at home and continue to receive amphotericin B infusion.
Journal of Primary Care & Community Health: Patient Perspectives on Home-Based Care and Remote Monitoring in Heart Failure: A Qualitative Study (10/28) - In this study, researchers conducted qualitative interviews with adults with heart failure. The study found that participants reported an understanding of care plan instructions and challenges adhering to care plans at home. Barriers included needing more home-based support for medications, diet, and fluid management and requiring additional assistance with financial barriers related to unmet social needs. A combined intervention inclusive of remote monitoring and home-based support has the potential to improve home-based strategies and clinical outcomes for heart failure patients.
McKnights Home Care: Home Health Spending Outpacing Rate of National Health Care Spending (10/26) - Spending on home healthcare rose by 10.5 percent in August, more than double the 4.9 percent increase in health care spending overall, according to a report by research and consulting firm Altarum. Spending on skilled nursing care wasn’t far behind, expanding by 10.2 percent. An increase in both utilization of services and higher prices for those services contributed to the increase in healthcare spending, with price growth being the largest contributor. Price will play an increased role in spending growth in the near future as “newly negotiated government-set prices catch up with higher input costs driven by overall inflation.
Hypertension: Comparing Pharmacist-Led Telehealth Care and Clinic-Based Care for Uncontrolled High Blood Pressure: The Hyperlink 3 Pragmatic Cluster-Randomized Trial (10/25) – A study published in theAmerican Heart Association’sjournal Hypertension found that telehealth care by pharmacists is an effective alternative to clinic-based care for managing high blood pressure. For the study, researchers compared two types of care for moderately severe, uncontrolled high blood pressure: traditional clinic-based care, using face-to face visits with doctors and medical assistants, and telehealth care, with home blood pressure telemonitoring and home-based care coordinated via telephone by a pharmacist or in some cases, a nurse. The telehealth and the clinic-based care were both successful in lowering blood pressure on average. The findings suggest that telehealth care that includes extended team care is an effective and safe alternative to clinic-based care for improving patient-centered care for hypertension. For additional coverage, see the American Heart Association press release and mHealth Intelligence.
Home Health Care News: Informal Caregiver Hours On The Rise, Highlighting Need For Home Care, Respite Services (10/24) - A survey from Homethrive found that there has been a 151 percent increase in the number of employees spending more than 9 work hours weekly on caregiving compared to its last survey in 2021. Homethrive’s survey examines how informal caregivers are balancing work life and their additional caregiving responsibilities. Two hundred informal caregivers — working in a variety of industries in the U.S. — were surveyed for the report. Homethrive’s survey findings come at a time when there has been a spike in MA plans including home-based care and respite care services in their offerings.
US News and World Report: Age Matters for Use of At-Home Tests (10/23) - The National Poll on Healthy Aging survey, conducted by the University of Michigan Institute for Healthcare Policy and Innovation, found that about 82 percent of adults between 50 and 80 years of age said they would be somewhat or very interested in taking an at-home medical test. About half had bought at least one, including 32 percent who purchased COVID test kits.
News and Market Developments
The Hill: Home Care is an Integral Part of the Health Care Industry - Cuts Will Devastate Access to Care (11/3) - A former intensive care unit nurse, Jennifer Sheets, shares the importance of breaking down silos across the continuum and improve the coordination of care to help patients and their family members gain more control over their medical journey, and in the process further enable better health outcomes. CMS should treat home health consistently — and apply the same budget methodology principles as it does in analyzing budget neutrality in the skilled nursing facility payment system.
Home Health Care News: Additional Takeaways From The 2023 Home Health Final Rule (11/3) - Following CMS' release of the final payment rule, it is critical for each home health agency to figure out its own financial standing and strategic plan for 2023. In addition, agencies should be finding key areas for improvement and educating clinicians on the recalibrated case-mix weights and Low-Utilization Payment Adjustment (LUPA) thresholds.
McKnights Senior Living: CVS Plans to Sell Omnicare Long-Term Care Pharmacy Business (11/2) - CVS Health plans to sell its long-term care (LTC) pharmacy business, Omnicare, reporting a $2.5 billion loss related to it in the third quarter. For accounting purposes, Omnicare met the criteria for held-for-sale accounting and the net assets were accounted for as assets held for sale. The carrying value of the LTC business was determined to be greater than its fair value and a loss on assets held for sale was recorded during the third quarter of 2022.
Healthcare IT News: Nuvance Health Develops New Memory Care-At-Home Platform (11/1) - Nuvance Health's remote monitoring program for neurodegenerative conditions provides individualized care with brain-stimulating activities, memory training, and patient and caregiver education. Along with telehealth, remote patient monitoring programs grew during the COVID-19 pandemic because federal rules gave providers the flexibility to use RPM for the duration of the public health emergency. More and more health systems are developing and launching remote care and hospital-at home programs, some tailored to specific clinical use cases.
Home Health Care News: VillageMD Reportedly In Talks To Merge With Primary Care Provider Summit Health (10/31) - Home-focused primary care provider — and key Walgreens Boots Alliance investment target — VillageMD is said to be eyeing a potential merger with Summit Health. The merger would value the combined companies at an estimated $5 billion to $10 billion. Summit Health is a primary and specialty care provider that was formed by the 2019 merger of Summit Medical Group and CityMD. The organization has over 2,800 providers, 13,000 employees, and more than 370 locations in New Jersey, New York, Connecticut, Pennsylvania and Oregon. The companies are rumored to be in talks, and a potential agreement could be formed in the coming weeks. However, negotiations could still fail to result in a deal.
Modern Healthcare: Can Best Buy Bring the Geek Squad to Health Care? (10/31) - Best Buy’s Geek Squad is taking its talents into the home to connect remote patient monitoring devices with hospitals. Best Buy is working to develop relationships and build up their customer base on the provider and the health plan side. The virtual care business combines capabilities from the GreatCall (which was renamed Lively) and Current Health acquisitions. The company’s health care presence comes as providers and insurance companies, primarily through their Medicare Advantage plans, invest in care at home. There is enough momentum in Medicare Advantage to build a reimbursement strategy for hospital-at-home programs. Many health systems are lobbying for an extension in the hospital-at-home waiver or the chance to try out a permanent model through Center for Medicare and Medicaid Innovation.
McKnights Home Care: CEO of Digital Startup Focuses on Transitions to Home (10/31) - Lee Teslik, founder and CEO of Reverence Care Company shared that there's a really important moment within the context of the system and an underutilized one where there’s a lot of opportunity to make things better. The company launched in May with start-up capital of $9.5 million. The firm’s first order of business was buying another company, FlexForce, which had an automated scheduling platform. While the scheduling technology works with a variety of provider groups — from home health, home care, physical and occupational therapy, and long-term care facilities — to help manage personnel across locations, the bigger aim is to improve transitions to home.
McKnights Home Care: Medicaid Must Do Better, Experts Tell Commission (10/31) - Medicaid’s barriers to access are making it difficult for hundreds of thousands of people to thrive in their communities under the program, according to policy experts who testified last week before the Medicaid and CHIP Payment and Access Commission (MACPAC). Medicaid beneficiaries in many states are on wait lists for caregivers because there simply aren’t enough available workers. A 10 percent increase in the Federal Medical Assistance Percentage (FMAP) to state Medicaid programs under the American Rescue Plan Act helped boost wages for home care workers. However, the pay is still too low to attract enough caregivers. Training for home- and community-based settings (HCBS) workers is lacking and needs to be more focused on social determinants of health, which help patients thrive in their homes and communities.
KERA News: How a New Hospital-At-Home Program Helps Patients and Parkland Hospital (10/31) - The pandemic and shortages of physicians and nurses have put a strain on hospital staff and capacity. Parkland Hospital’s starting to address some of those problems by delivering acute care directly to the patient. Patients in this program tend to have fewer visits to the emergency department, fewer 30-day readmissions, and less utilization of our laboratory and radiology services. When Parkland sees those resources are not being used as much, it can lower costs.
Home Health Care News: Cigna Forms Partnership With Heal To Offer MA Members Home-Based Care (10/28) - Cigna’s Medicare Advantage (MA) members in certain markets will now have access to home-based primary care through Heal, a Los Angeles-based in-home primary care provider with a senior care focus.. The provider recently announced that it has formed a partnership with Cigna, and is now part of the organization’s network in Georgia, Illinois, North Carolina and South Carolina. As a part of Cigna’s network of providers, its MA members will have access to services one would expect from a traditional primary care office. This means doctors visits, annual wellness visits, flu shots, specialist referrals, telehealth services, remote patient monitoring and more.
Home Health Care News: Help at Home Launches Care Coordination Service Arm (10/28) - The Chicago-based personal home care company Help at Home announced a new segment of their business that will focus on care coordination. Help at Home Care Coordination will attempt to transform the delivery of in-home personal care, increase access to care and improve quality outcomes and client satisfaction for seniors aging in place. The new model will connect caregiver observations to a network of providers and community resources to create a holistic experience for the patient. The new care coordination model will be available for Help at Home’s Medicaid, Medicare and dual-eligible client populations across the country.
Home Health Care News: Voices Interview with Beth Ann Longo from The Joint Commission (10/28) - In this Voices interview, Home Health Care News sits down with Beth Ann Longo, Associate Director of The Joint Commission’s Department of Research, to learn about the value of Joint Commission accreditation for home-based care providers. Longo also shares results from a recent Joint Commission study on home health agency performance with and without Joint Commission accreditation.
EHR Intelligence: Home Health Agencies Look to Epic, MEDITECH EHR Implementations for Interoperability (10/28) - Home health agencies are looking to electronic health record (EHR) implementations from vendors like Epic and MEDITECH to improve interoperability and operational efficiencies. A KLAS report found that health system decision-makers are more satisfied with the Epic EHR than home health professionals. Decision-makers note integration as the main strength of the system, as it allows organizations to consolidate vendors. Customers also appreciate the EHR vendor’s willingness to take feedback around developing new functionality to meet customers’ needs. Home health professionals would like to see some platform enhancements, such as improved capabilities for documenting on touch screens and better alignment between Remote Client and Hyperspace.
Yahoo Finance: DispatchHealth and Home Instead Announce Collaboration to Offer In-Home High Acuity Care to Home Instead Clients Across the Nation (10/27) - Global home care provider for aging adults, Home Instead and DispatchHealth announced their nationwide collaboration to provide in-home acute care for Home Instead Clients. This partnership will enable Home Instead, an Honor Company, to provide their Clients with a new way to receive convenient medical care in the comfort of their own homes. DispatchHealth’s proven platform provides care to patients at home and coordinates support for ongoing needs with their care teams. For additional coverage, see McKnights Home Care.
McKnights Home Care: Home Health, Hospice Gearing up for Major Challenges (10/27) - The home health field is poised for the release of the final home health rule from the Centers for Medicare & Medicaid Services. Meanwhile, hospice providers are waiting on updated survey guidance, which will overhaul the public reporting process and create a special focus facilities program. National Association for Home Care & Hospice’s (NAHC’s) Calvin McDaniel, director of government affairs, and Davis Baird, director of government affairs, hospice, recently broke down the significance of these items for McKnight’s Home Care in a Newsmakers podcast.
Yahoo: Satellite Healthcare Introduces an Innovative Care Model for People Newly Diagnosed with Kidney Disease Requiring Dialysis (10/27) - Satellite Healthcare, a non-profit, top-rated provider of kidney dialysis and related patient services, announced the opening of Kidney Care Connection (KCC), a new care model created specifically for individuals who have recently learned they have kidney disease requiring dialysis. Patients who start their treatment at KCC will use the same medical equipment they would use in a home setting, and, if they choose to, can transition to dialyzing at home after four to eight weeks. Home dialysis therapies are associated with patient longevity, a higher quality of life, and shorter recovery times after treatment.
Stat News: Home Health Care is Facing Devastating Clawbacks (10/26) - Home health care services have helped keep families healthy and safe, as well as reduce stress. However, it isn't equally accessible to everyone. Terry Wilcox shares his thoughts in this First Opinion podcast.
Politico Pro: Critical Intervention Needed for Remote Care (10/26) – Large health systems are investing big money to provide more health services at home — everything from post-operative care to treatments for chronic disease. But even as successive administrations have touted remote patient monitoring programs as a key to improving health and reducing unnecessary government spending, state Medicaid offices remain an impediment to scaling them nationally, refusing coverage for low-income residents who suffer from chronic diseases at higher rates than Americans with private insurance. Many states have declined to pay for them, in part because the upfront legwork and bureaucratic headaches can be stifling to officials who deal in yearly budget cycles and rarely get credit for savings decades down the road.
Home Health Care News: Humana, Monogram Health Team Up To Bolster In-Home Kidney Care Capabilities (10/26) - Humana Inc. and kidney care provider Monogram Health have reached a new value-based care agreement for Humana Medicare Advantage members in four southern states. Most Humana Medicare Advantage HMO and PPO plan members in Tennessee, Alabama, Louisiana and Mississippi can now access Monogram’s specialized resources, which include in-home primary and specialty care visits, medication management, dialysis, palliative care and more. For Monogram, the partnership gives it the ability to bring more value to Humana and its members. For additional coverage, see Business Wire.
MobiHealth News: CVS Health Partners with ixlayer for Branded At-Home Testing Kits (10/26) - Digital diagnostics company ixlayer announced it will produce CVS Health's branded at-home sample collection kits. Ixlayer's kits can test for Lyme disease, Vitamin D levels, thyroid function and sexually transmitted infections. Users are also provided education and information about what the results mean. Consumers can now purchase the CVS Health-branded tests online or pick up a test in-store at select CVS locations.
Politico: Why Medicaid is Blocking Patient Home Monitoring (10/26) - Many state Medicaid offices are stymieing the use of remote patient care, refusing coverage for low-income residents who suffer from chronic diseases at higher rates than Americans with private insurance. While the Centers for Medicare and Medicaid Services (CMS) has some reimbursement codes for remote monitoring, states have broad discretion to set their own rules. Around 20 state Medicaid programs don’t reimburse for remote patient monitoring, according to data from the Center for Connected Health Policy. Several states that pay for remote monitoring have stringent restrictions around its use.
Health Leaders: Digital Health Technology Aims to Identify Flu at Home (10/26) - Digital health companies and health systems are applying lessons learned during the pandemic to design tools, including apps and wearables, that can help consumers identify health concerns like infectious viruses and access resources for treatment. These platforms can help healthcare providers reduce waiting room and ED traffic and improve time to treatment, while businesses, schools and government offices can use them to monitor employee health. The technology is part of a trend that's pushing health care out of the clinic, doctor's office, and hospital and into the home and other remote locations.
Home Health Care News: HHCN FUTURE Conference: Fireside Chat with Homecare Homebase (10/26) - In this interview with Scott Decker, CEO of Homecare Homebase, Home Health Care News explores the Medicare rate environment next year and how home health providers could be impacted by the proposed rule’s changes.
Home Health Care News: DUOS Hopes To ‘Simplify’ At-Home Care With Magellan Healthcare Assistance Program (10/25) - Magellan announced the launch of its new Senior Assistance program, powered by DUOS. The new service will allow Magellan members to get connected with personal assistants — or “Duos” — who focus on members’ social needs to help maximize their independence while aging in place. The duos will also be able to coordinate community resources for health plan members to make at-home care a more holistic and personalized experience. The Magellen and DUOS pilot resulted in a 93 percent success rate in addressing members’ social determinants of health needs and an 85 percent retention rate. Through the Senior Assistance program, Magellan members will receive a personalized plan and weekly virtual check-ins to help them meet daily needs and hurdle other barriers that might be in the way as they age in place.
Healthcare Innovation: Health Systems Announce Virtual and In-Home Care Company (10/25) - The Medical University of South Carolina health system and the MetroHealth System announced a partnership, creating Ovatient, a virtual and in-home care non-profit company. The company will focus on building and maintaining connectivity to health systems and will provide the opportunity for health systems to combine resources and address health care workforce issues. Ovatient represents an opportunity to multiply collective wisdom and clinical expertise in telehealth and care delivered in the home. For additional coverage see mHealth Intelligence.
McKnights Home Care: Long-Term Care Needs a 'Shift' in Perception, Strategy, Experts Say (10/25) - A panel of experts called for a new approach to Medicaid funding and long-term care services Monday during a virtual town hall sponsored by Yale Law School’s Solomon Center for Health Law and Policy. Medicaid’s shift toward home- and community-based services is putting more of a burden on family and friends to provide caregiving. Policymakers at the federal and state level need to re-center the conversation about long-term care around the unpaid caregivers providing and managing support, in addition to those who need it. Finding policy solutions in Washington could become even more challenging if the House and Senate flip to a Republican-controlled majority in the upcoming midterm election. Republicans are more likely to favor tax credits and expanded family leave to help family caregivers.
Home Health Care News: Why Clover, SCAN Have Long Embraced Home-Based Care (10/25) - Now more than ever, Medicare Advantage (MA) organizations are including home-based care services in their plans. While some organizations are giving their members access to these offerings for the first time, others have long embraced home-based care. One of these early adopters is SCAN Health Plan, which is one of the nation’s largest not-for-profit MA plans, serving more than 273,000 members. With that goal of keeping seniors healthy and independent in mind, home-based care has always been a key tool in achieving this.
Health Leaders: Innovative Partnership Power Mobile Integrated Health Programs (10/24) - Health systems and payers are forging partnerships with paramedics and other community health providers in mobile integrated health programs that bring home-based care to high-risk, high-expense patients. Mobile integrated health (MIH) and community paramedicine programs create pathways to send specially-trained paramedics to the patient's home for primary care services and wellness checks. These programs aim to reduce unnecessary and expensive ER transports and hospitalizations while improving health and wellness and long-term clinical outcomes.
Healthcare Exec Intelligence: How One Primary Care Organization is Boosting Value-Based Care for Seniors (10/24) - Through in-home and virtual primary care services, Heal aims to improve health outcomes, address SDOH, and reduce healthcare costs for seniors. Heal allows seniors to be independent and to be cared for at home as much as possible. It allows them to minimize being a burden on their family members and creating challenges for their family members in terms of getting access to care. The rise in virtual care adoption and at-home care, largely driven by the COVID-19 pandemic, has supported value-based care models that leverage telemedicine and RPM modalities, like Heal's.
Politico Pulse Check: What We Can Learn About Experiments in Remote Care (10/24) - Large health systems are investing big money into providing more care at home — everything from post-operative care to treatments for chronic disease. Even as successive administrations have touted remote patient monitoring programs as key to improving health and reducing unnecessary government spending, state Medicaid offices often remain an impediment to scaling them nationally. Ruth Reader talks with Katherine Ellen Foley about why.
The American Journal of Managed Care: Dr. Melissa O'Connor on Policy Reform to Address Unmet Needs in Home Health (10/23) - Melissa O'Connor, PhD, MBA, RN, FGSA, FAAN, endowed professor in Community and Home Health Nursing, M. Louise Fitzpatrick School of Nursing, Villanova University, and director, Gerontology Interest Group, discussed several policy needs for home health care, including improved caregiver support, updated eligibility criteria for in-home care, and reimbursement for telehealth. Along with better support of unpaid caregivers, there are several policy needs for in-home health care, including improved eligibility criteria and telehealth reimbursement.
MedCity News: How to Bring Direct Primary Care into the Home (10/23) - A primary care provider may visit some homebound patients in their homes two or three times a year, with allied and affiliated care providers delivering other services as needed to the patient, such as wellness visits, nutritious meals, groceries, and assistance with daily activities. McKinsey estimates that up to $265 billion worth of care services (representing up to 25 percent of the total cost of care) for Medicare fee-for-service and Medicare Advantage beneficiaries could shift from traditional facilities to the home by 2025. As more primary care is delivered into homes through DPC and more traditional care models, a collaborative, team-based approach involving multiple disciplines and services is essential to improving health equity for those who need it most.
November 13-16, The Healthcare Ecosystem Platform, "HLTH2022". In-Person event in Las Vegas, NV.