Department of Health and Human Services secretary Tom Price resigned from his post Friday amid an investigation into his use of private jets at taxpayer expense.
As head of HHS, Price had most recently impacted the home health care industry after announcing some mandatory bundle payment initiatives would become voluntary.
The government spent more than $1 million for Price’s travel on private and military aircraft since May, according to Politico, which first reported on the secretary’s travel habits. Those trips included 26 charter flights within the United States, and additional travel on military aircraft to Africa, Asia, and Europe, Politico reported.
The White House issued a terse statement Friday afternoon announcing the designation of acting secretary Don J. Wright, currently the deputy assistant secretary for health and director of the Office of Disease Prevention and Health Promotion.
“Secretary of Health and Human Services Thomas Price offered his resignation earlier today and the president accepted,” White House Press Secretary Sarah Huckabee Sanders said in the statement.
Price had volunteered to pay back nearly $52,000 in travel expenses on Thursday, but that was before Politico broke the news of the overseas military travel. The now-former secretary had left the House of Representatives, where he represented Georgia’s 6th district, to accept the post in the Trump administration.
Earlier in the day Friday, the President had indicated that he would make a decision about Price’s continued employment as HHS secretary by tonight.
Written by Alex Spanko
Preparation is key for any emergency, but it’s just one half of the equation. As in-home care providers found out during recent hurricanes that battered Texas and Florida, putting the protocols into action is the true test.
Here are some of the top lessons affected providers learned in the aftermath of Hurricanes Harvey and Irma:
Communication and Coordination
Houston-based Genova Health walked away from Hurricane Harvey with one lesson: Communication and coordination between all team members is key to keeping operations going. Genova Health offers care management, skilled nursing and home care services, the last of which operates under its Family Tree In-Home Senior Care brand.
As Harvey pummeled the Houston area in early September, Family Tree was unable to service roughly 50% of its clients due to flooding and closed roads. It took the group one week after the storm to be 100% fully operational, according to Kevin Baxter, director of operations at Family Tree.
In addition to daily e-mails alerting all staff of weather conditions, personal phone calls were made to every single caregiver by care advisors and upper management to not only determine their safety and well-being, but to also check their availability and schedule staff, explained Baxter.
For home care franchise owner Andy Corbett, who has an Executive Care location in Clearwater, Florida, having a landline proved to be valuable in the wake of Hurricane Irma. With some cell towers out, Corbett could reach caregivers, clients and family members when others couldn’t.
While the office lost power for five days, Corbett and caregivers stayed in touch with one another by holding staff meetings in a parking lot; when calls couldn’t cut it, Corbett’s team would drive to check in on clients, as the Clearwater area was not terribly ravaged by the storm.
Palm Beach County Senior Helpers franchise owner Michael Mohl told HHCN that the biggest lesson learned from Hurricane Irma is that cell towers can go down. Senior Helpers, which specializes in personalized in-home senior care, has roughly 300 locations.
“One of the biggest lessons we learned from Hurricane Irma was that even though we took precautions with cell phones, we did not expect the cell towers to lose power so quickly,” he said. “The lesson learned here is that we need to prepare with radio handhelds for caregivers as a third backup, as our first and second methods of communication weren’t accessible.”
Communication with other health care providers and state organizations is also a critical piece to emergency preparedness, according to Paul Ledford, CEO and president of the Florida Hospice and Palliative Care Association.
“Part of that emergency preparedness is engaging and developing relationships with state and local organizations,” he told HHCN. “Florida has a truly remarkable and robust emergency preparedness system. The average hospice in Florida is seven to eight times the size of a hospice nationally, and that’s part of the reason why these programs are so robust.”
Patient Triage and Mapping
Assessing acuity levels of patients is a crucial step in preparing for a storm, and triaging patients during an emergency ensures that the most frail get care right when they need it.
Family Tree triaged patients into four different levels ahead of the storm: Level-One and Level-Two patients were those who required urgent care and were assigned a caregiver during the storm. For Level-Three and Level-Four patients, it was determined care could be postponed between one to four days after the storm hits, according to Baxter.
With this knowledge on hand, caregiver and client locations were mapped to help managers assign caregivers based on their proximity to high-actuity patients. This tool became a great asset for the company during the storm, according to Daniel Gottschalk, co-founder and president of Genova Health.
“Because we had that information so readily available … [Baxter] already had all the data he needed in order to respond appropriately to the disaster,” Gottschalk told HHCN. “We knew which areas in Houston were flooded first and where we were most susceptible, so we knew which caregivers needed our help first.”
For Corbett, in Clearwater, many of his clients and caregivers evacuated the area, with some heading out of state and staying with relatives.
“A lot of clients left the area, or they went to facilities,” he said. “None of our patients had much impact, fortunately. Several families took
In the future, Corbett says he will ensure that the office has all the evacuation addresses for caregivers and clients, as well as additional contact information to be better prepared. He will also ensure that some clients can make it to other facilities easily, as those designated facilities that can take care of patients with special needs tend to fill up, he said.
“We were scrambling a bit at the last minute, and that won’t happen again,” he said.
Part of the issue may be the resiliency of Floridians, Corbett said, stating that the Tampa-Clearwater area has largely been shielded from hurricanes over the past few decades. As such, residents may not take hurricane threats very seriously.
“In this area, the people are immune to hurricanes,” he explained. “They always say we are going to get them, and we never do. This was a wake-up call [that] you cannot leave you mother alone on the beach. Until you go through a hurricane, you don’t realize.”
The evacuations did, however, impact the business, and one client has yet to return to Florida from out of state, Corbett said.
In the aftermath of Hurricane Harvey, Gottschalk explained that business has picked up as the company lends its hands to help other senior care companies in their recovery efforts.
“Because we had coordinated efforts beforehand, we all were very friendly when the storm hit … We were able to work with our competitors during the storm to help out clients,” said Gottschalk.
Others have not seen business pick back up fully.
“As far as loss of business, I estimate we had a 5% decline in sales despite the fact that we had caregivers on 24/7 duty during and directly after the storm to protect and take care of our clients,” Mohl said.
Executive Care in Clearwater was all hands on deck to help out the area. After appearing on a local news channel about storm preparations, Corbett was inundated with calls from folks—who were not home care clients—in the area needing help. He decided to run a food and water drive, and even pull his marketing staffer from the road to deliver food to those in need.
“Some of these people can’t drive, they can’t get food,” he said. “They have no resources at all, the buses aren’t running, and they have nothing. Those are the people we were trying to help. My teams’ efforts delivered and organized [the drive], and it was so good of them to sacrifice their day off and do food delivery.”
Ensign Group Acquires Nevada Hospice Operations
The Ensign Group (Nasdaq: ENSG), the parent company of the Ensign group of skilled nursing, rehabilitative care services, home health care, hospice care and assisted living companies, has acquired a hospice provider serving Southern Nevada through a subsidiary of its home health and hospice portfolio, Cornerstone Healthcare, Inc. The subsidiary acquired Comfort Hospice Care, which serves Las Vegas, Pahrump and surrounding communities in Southern Nevada.
With the acquisition, Cornerstone subsidiaries now operate 22 hospice operations, 18 home health operations and three home care operations in 10 western states. Cornerstone is actively seeking additional opportunities to acquire both well-performing and struggling home heath, hospice and home care operations across the country.
“Comfort Hospice Care is a strategic addition to Cornerstone’s hospice operations,” Ensign President and CEO Christopher Christensen said in a statement. “It adds to our existing assisted living operations in Las Vegas, and expands our footprint outside of the Las Vegas metro area to provide care in rural areas across Southern Nevada.”
LHC Group and CHRISTUS Health Finalize Joint Venture Agreement
LHC Group, a Lafayette, Louisiana-based national provider of post-acute health care services, and Christus Health, an Irving, Texas-based Catholic nonprofit health system, finalized a joint venture partnership to expand home health, hospice and long-term acute care services in Louisiana, Texas, Arkansas, and Georgia, according to a press release from LHC Group.
The agreement includes LHC Group taking majority ownership of Christus Health’s home care and hospice services, as well as its long-term acute care hospital (LTACH) facilities. LHC will also take over management of these properties and services, though they will continue to operate under their existing names.
The joint venture will impact 21 services locations of Christus Health, including seven home health agencies, five hospice programs, two community-based home care services, one inpatient hospice unit, and six LTACHs.
Jordan Health Services Acquires Two Oklahoma Home Health Care Providers
Jordan Health Services, a Dallas-based provider of home health and hospice services, acquired two Oklahoma home health care providers, in an effort to expand Jordan’s footprint in the state.
The two acquired companies are Oklahoma Medicaid Operations from Kindred At Home, a home health care provider that serves nearly 3,500 patients in Oklahoma, and Ross Health Care, an Oklahoma-based home health, hospice and private duty provider, comprised of Alliance Health, Inc., Ross Home Health, and Ross Hospice. Ross provides care to more than 900 patients in Oklahoma.
The terms of the transactions were not disclosed.
Jordan provides home health services in Texas, Oklahoma, Louisiana and Arkansas.
CareCentrix Partners with Medullan
CareCentrix, a home health management solutions provider, has entered into a strategic partnership with Medullan, a digital health firm that designs outcomes-driven solutions for the health care industry. The alliance aims to develop care tools that connect providers, patients and payers through mobile technology for patients outside the hospital setting.
The partnership aligns Medullan’s care experience platform, VARA, with CareCentrix’s HomeBridge technology.
CareCentrix also entered in an alliance with Owned Outcomes, a software company that provides analytical help to health care providers as they enter payment arrangements that include financial and performance accountability for patient care. The alliance aims to deliver predictive, actionable insights to post-acute care networks using machine learning and artificial intelligence.
Home Health United Changes Name
Home Health United, a home health agency based in Madison, Wisconsin, has changed its name to SSM Health at Home, according to the Wisconsin State Journal.
The agency has been owned by SSM Health St. Mary’s in Hospital in Madison, as well as SSM Health St. Clare Hospital in Baraboo, Sauk Prairie Healthcare and Reedsburg Area Medical Center, the journal reported. Home Health United has five medical equipment stores and 11 offices in 22 counties.
Written by Amy Baxter
A telehealth startup that helps patients with palliative care and advance care planning is expanding after raising $5.1 million. Palliative care is a type of care focused on lessening the symptoms and stress caused by a serious illness.
Austin, Texas-based Iris Plans uses videoconferencing technology to connect people facing serious illnesses with trained facilitators who provide disease-specific education, help with decision-making and assist in completing and distributing advance health care directives. A patient’s thoughts and plans are documented and shared with their loved ones, physicians, the hospital system they use, and are also available online.
The financing round was led by New York City-based Activate Venture Partners and Austin-based LiveOak Venture Partners, both of which invest in digital health care companies. Oakland, California-based Better Ventures also joined the round. This was the company’s first round of financing.
Iris Plans’ service is delivered through partnerships with national health care providers and insurance companies, who cover all of the cost for their members. Iris Plans currently serves a customer network of health plans and systems, accountable care organizations and nursing facilities, including senior living and home health care provider Brookdale Senior Living (NYSE: BKD) and Humana. The startup also last year teamed up with University of Utah Health Plans, which has more than 155,000 members.
Iris Plans will use the new funding to improve and streamline its technology platform and hire more developers, marketers, IT staffers and other employees.
The startup will also expand its national partnerships with health care providers and payers, according to Dr. Stephen Bekanich, co-founder and chief medical officer of Iris Plans.
“We are in advanced discussions with a variety of health plans and health care providers spanning across the country and expect to be growing our footprint from coast to coast in the coming months,” Bekanich tells Home Health Care News.
Written by Tim Regan
This summer, the Justice Department announced the largest health care fraud takedown ever, involving schemes across several health care settings resulting in approximately $1.3 billion in false billings. Major home health schemes were uncovered as part of the takedown, and the announcement sent a message to fraudsters—federal agencies are cracking down.
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) charged more than 400 individuals for their roles.
“In general, and home health care would be a part of this, the Office of Inspector General (OIG), has really ramped up their focus on health care fraud from the recent settlements,” Venson Wallin, managing director, CPO for the BDO Center for Healthcare Excellence & Innovation. The BDO Center is a consulting firm for the health care industry with advisory services, a capital investment bank, and audit and tax professional services.
In addition, sentences for home health care fraud are, arguably, getting harsher, as evidenced by the 75-year sentence handed down to a woman for her part in a $13 million fraud scheme. Another case resulted in a 40-year sentence. More recently, OIG announced it will perform a 2018 review of a new, optional Medicaid benefit, Health Homes, which coordinates care for patients with chronic conditions.
Growth in Home Health
The crackdown may be a response to the growth of the home health care space, according to Wallin.
“With the proliferation of patients, there is a proliferation of providers offering services,” Wallin said. …”When you have an uptick in the market, you also have some players that come into the market and their intent is to take advantage of the system.”
With more players, not everyone is playing by the rules, and a number of recent cases underscore just how rife with fraud the industry can be.
“The demand has spurred more players,” Steven Shill, national co-leader of The BDO Center, told HHCN. “Obviously, there are some very large home health companies out there. More and more people have been attracted to the industry. Mom-and-pop [providers] have been attracted because of the demand and relative ease with which they can access the industry. And I think that’s another reason why it’s being looked at very carefully [by the OIG].”
Fraud investigations may also appear to be ramping up, with bigger grabs by federal agencies, due to the introduction of increasingly sophisticated tools used to identify patterns of unsavory business practices. In other words, the good guys now have data analytics to find the bad guys quickly.
“The introduction of data analytics into the process, into the investigatory process, has provided them with a tool that, before the last couple years, they did not have,” Wallin said. “Now, they have the ability to run data analytics on claims by providers, and can tell when things don’t look right. …Whereas before, they just happened to come across something, now they actively pursue and go after outliers [in the data].”
With this in mind, it’s more important than ever that home health care providers have a solid understanding of their own data—and how they match up against their peers.
“There may be an excellent reason why you’re an outlier,” Wallin said. “You need to have a story as to why you’re an outlier, why it’s appropriate. It could be because you have better quality outcomes metrics than anybody else in the area, and are more critically responsive [to] patients.”
The use of these new resources also coincides with the implementation of a new revenue recognition rule, ASC 606. The rule essentially requires health care providers to report revenues in a way that is a bit more universal, rather than industry-specific, and it impacts all entities that enter into contracts with customers for goods or services. In health care, the new standards are easier said than done, as revenues are often diverse across different business lines and can be tied in with initiatives like value-based purchasing models.
“The revenue recognition is going to add some complexity, and could lead to misreporting as well,” Wallin said. “It will be easy to misinterpret some of the rules and lead to another set of issues.”
The rule goes into effect for the fiscal period after December 15, 2017 for public companies, and 2019 for non-public entities. It will have particular impacts in M&A for home health by increasing complexity and costs, as entities will likely undergo more stringent auditing of financial records when conducting a transaction.
The investigations of fraud aren’t likely to slow down anytime soon, as the return on investment of going after fraudsters is a huge payoff for federal agencies.
“The government makes $6 for every $1 they spend [on these cases],” Wallin said. “There is not shortage of intent by the government to content to pursue incidents of fraud and alleged fraud.”
However, there are many practices for home health care providers to avoid being at high risk for compliance issues.
For one, providers should understand their position in the market and data.
“It behooves most providers to have systems and processes in place so they do understand where they are on the spectrum,” Shill said. “It’s definitely great business practice from a regulatory and operational standpoint to understand what the landscape looks like. From there, you need good data and quality individuals entering the data.”
Data will also play a key role in the new revenue reporting requirements.
“If you do have a decent way to analyze your outcomes and the data that relates to your operations, you would do better to have a lock on what your costs are,” Shill said. “That, in the new world of value-based care, is going to be tremendously important.”
Written by Amy Baxter
While ride-sharing apps like Uber and Lyft have certainly become common tools across the in-home care industry, one Dallas-based software developer is looking to capitalize on the trend by adapting the on-demand trend for in-home care services—and put power in the hands of nurses with more control over their schedules.
Axxess, a developer of cloud-based software solutions for the home health industry, looks at “Uber-izing” the industry through its new app, AxxessCare. The app, which is currently in the pilot phase in the Dallas-Fort Worth market, takes Axxess’ scheduling capabilities for clinicians, agencies and patients on the go, and gives nurses the power to match their schedules and preferences with patient cases. Axxess is a major tech provider in the home health care space, with more than 1,700 providers on its platform which includes electronic medical records (EMRs) in addition to scheduling technology.
Home Health Care News caught up with Dennis Petrosky, SVP of corporate communications, and Shradha Aiyer, director of mobile technology at Axxess, to talk about the concept behind the app and the role technology has played in the industry.
What was the impetus behind developing the AxxessCare app?
Aiyer: When you look at nurses, they want to work in the area of their preference. Right now, they have to drive for hours to do a visit because they work with one agency that services a particular area. [Likewise], agencies are not able to grow their business because they cannot find qualified professionals who are willing to go to different areas. And unfortunately, patients don’t get seen in time and they have to get transferred between facilities before they get the care they need.
Another reason why we looked at AxxessCare and the need for it is you might need specific care, but you only get a general nurse coming in to give you that care … [The ability to select a specialized nurse] really elevates the quality of care that [patients] are going to receive. We’re trying to connect these clinicians who are proficient in certain areas to the needs of that patient, and we wanted to build a transparent highway to be able to connect these people.
What problems does the app solve?
Petrosky: We really see this as sort of a win-win-win for everybody because the agencies have an added pool of people who are qualified to be able to serve the patients in a particular area. The clinicians have the opportunity to raise their hand to say “I want to be considered for this opportunity if it meets my pay requirement and my location requirement.”
[Clinicians] can set filters through their app that will only meet the requirements that they’re looking for and then they can raise their hand and the agency has an opportunity to engage with them to ensure that they have the qualifications and the expertise that they need to best serve the patient.
How does the app address or combat recruiting and retention issues within the industry?
Aiyer: It comes back to empowering the people who are doing the work. … A lot of times, unfortunately, depending on your location, either the nurse is overcharging the agency or the agency is underpaying the nurses. So, we want to help create that level of transparency and even truly share analytical information about different hot spots and areas for the industry, and really help them understand best practices with respect to hiring and retention.
How would you describe the role of apps in home health care? What are your expectations for the future?
Aiyer: I feel like, unfortunately, with home health, we’ve not embraced technology as well as we should, especially with the advent of mobile devices. There are so many things that a clinician can do in their pocket—from making sure that they get their work done on time to helping them make their lives easier. That’s what I see technology doing; it’s ensuring accountability.
The more we embrace that technology, the better it is, and it’s not just apps within Axxess. There are a lot of great applications for all of health care that home health can embrace. Medication reconciliation is something that has always been so frustrating for clinicians, but there are so many apps out there that help them look up medicines and look up interactions. There are teaching and training videos online that they can pull up using their phone. There are a lot of different resources that are in the palm of their hands and should be embraced more and more.
Petrosky: What we’re developing with AxxessCare is very similar to the ride-sharing programs that have been developed in that they give convenience and control to everybody that is in the process. In the ride-sharing apps, the drivers set their own schedules, the riders have visibility on who’s out there and what the cost is—everything is very transparent.
It’s very similar in what we’re doing with AxxessCare in that agencies can see who is available and who is qualified to handle their need, and at the same time, their clinicians have an opportunity to identify the work that they are interested in taking. So it really is very much about visibility, convenience and control.
Written by Carlo Calma
The home health care industry is fighting back against the proposed Home Health Groupings Model (HHGM), and a new social media and phone campaign aims to bring President Trump into the issue.
The National Association for Home Care & Hospice (NAHC) has launched a digital campaign to rouse home health and hospice stakeholders to tweet at, post about and call the White House about the groupings model, which threatens to cut $950 million in payments in 2019 alone. The campaign, which is based on a NAHC web page, enables anyone to post, tweet or call with the click of a button. The tool was put together in collaboration with government relations and public affairs counsel group Liberty Partners Group, a software company based in California, and NAHC.
“This year, we have taken a number of steps to energize virtual advocacy, compared to the standard Washington scene to lobby and walk the halls of Congress, seeing Congressional members and staffers,” Bill Dombi, interim president of NAHC, told Home Health Care News. “But in virtual campaigns, we can have a much more amplified voice in terms of number of people.”
Namely, Dombi noted the roughly 2 million caregivers in the U.S., and millions of people who utilize or know someone who utilizes home-based care services.
The industry found some success in its efforts to fight back again the groupings model, as more than 1,300 public comments were posted to the Federal Register in response and 49 U.S. Senators signed on to a letter urging CMS to pull back the model.
Now, NAHC wants home health players to get in touch with the White House, and specifically President Trump, who is well-known for his active Twitter account.
“We believe one of the forces at play is the Office of Management and Budget (OMB), and OMB is part of the White House,” Dombi said. “We think targeting the White House makes a lot of sense. The president heads up all of the agencies… we figured we’ve got to do something a little different to keep people engaged in advocacy.”
The NAHC campaign instructs participants to #SaveHomeHealth in a direct tweet to the president’s Twitter handle.
“Best case scenario is the president tweeting out, ‘I’m on board with you,’” Dombi said. “That would make us delirious.”
However, NAHC is not expecting that response. Instead, the association is looking to add tens of thousands of people—and potentially hundreds of thousands—to the discussion through social media and virtual lobbying.
The groupings model, which was introduced in the Home Health Prospective Payment System (PPS) 2018 Update, proposes a number of changes that would radically change the way home health agencies operate, including redistributing reimbursement rates and changing the current 60-day episode of care to 30-day payment periods.
The campaign is not likely to be a one-off event for NAHC, which hopes to similarly engage constituents virtually in pressing home health issues down the road.
The full campaign can be found here.
Written by Amy Baxter
Home-based services are increasingly getting more expensive thanks in part to ongoing labor woes, according to the latest Cost of Care Survey from insurer Genworth Financial (NYSE: GNW).
The national median cost of home health aide services shot up 6.17% to $21.50 per hour, or $4,099 per month, from 2016 to 2017—the most pronounced increase among other care settings, according to the survey. The cost of homemaker or home care services, including household tasks such as cooking and cleaning, reached a median of $21 per hour, or $3,994 per month, a 4.75% increase from last year.
Over five years, the median cost growth rate was 2.50% for home health aide services and 3.08% for homemaker services.
This year’s cost increase was particularly notable, according to Gordon Saunders, senior brand marketing manager for Genworth’s U.S. Life Insurance division. Overall, the annual median cost of long-term care services climbed an average of 4.5% from 2016 to 2017, marking the second-highest year-over-year increase for nursing homes and home care since the study began in 2004.
“We have become accustomed to seeing steady increases in the cost of long-term care services, but this year, we saw a marked acceleration in the cost of home care over previous years,” Saunders told Home Health Care News. “This is based on external factors in the marketplace related to supply and demand: increasing demand for long term care services as our population ages versus shortage of workers and rising labor costs.”
The vast majority of people prefer to receive some form of care in their homes, Saunders added, citing Genworth’s long-term care insurance claims.
By comparison, the national median cost for a one-bedroom unit in a private-pay assisted living community reached $3,750 per month, or $45,000 a year, according to the survey. That’s an increase of 3.36% from 2016 to 2017.
National median rates for semi-private room nursing home care increased 4.44% and hit $7,148 per month, and private room nursing home care reached $8,121 per month, a 5.50% increase.
Labor woes crank up costs
Though the ongoing labor crunch isn’t the only factor driving up the cost of care, it has impacted all care settings, according to Saunders.
“[U.S. Dept. of Labor] changes have resulted in minimum wage and overtime protections to more domestic service workers who enable individuals with disabilities and the elderly to continue to live independently in their homes,” Saunders said. “Also contributing to the increase in labor costs is the Affordable Care Act (ACA), which requires employers of a certain size to offer some type of health insurance, or pay a penalty.”
For nursing homes, higher labor expenses and tightening Medicare rules have resulted in shorter hospital stays and sicker patients being sent to rehab nursing homes for shorter stays, driving up costs, Genworth noted in the survey.
Room and board for assisted living communities has gone up to accommodate residents who are sick, but not sick enough to require nursing home care, according to the survey. Luxurious amenities commonly found in private pay communities also increased costs of care.
It’s clear costs are rising, but many people don’t believe they’ll ultimately have to pay for senior care services.
About two-thirds of respondents in a companion survey to this year’s Cost of Care report said they “expect government programs to cover all or part of their long-term care costs.” And although there are government programs in place to aid seniors, those programs are limited, Genworth notes.
Medicare will pay for skilled home health care, but most home care and homemaker services are paid out of pocket. Medicare will also pay for limited skilled nursing care following a three-day hospital inpatient stay. Medicaid, on the other hand, has different income and functionality requirements.
“Medicaid is the single largest payor of long-term care costs because so many people can’t afford to cover the costs themselves, but what many people often don’t realize is, they have to spend down much of their assets to qualify and their options for how and where they receive care may be limited,” Saunders said. “It usually takes personal experience caring for a parent or other family member for people to realize the enormous costs associated with long term care and wake up to the fact that they themselves need to do a better job of planning ahead for how they will cover these costs.”
Written by Tim Regan
Cuts to home health care payments under the proposed Home Health Groupings Model (HHGM) are deeper than predicted by The Centers for Medicare & Medicaid Services (CMS). That’s according to ElevatingHome, which ran an analysis of home health care claims with some of its members to look at the true impact of the model.
The groupings model, which was introduced in the proposed 2018 Home Health Prospective Payment System, has been met with significant opposition from the home health industry, and 49 U.S. Senators recently signed onto a letter originated by Marco Rubio (R-FL) and Bill Nelson (D-FL) urging CMS to keep the groupings model out of the 2018 proposal.
While CMS predicts that the model will cut $950 million in payments in 2019, providers were surprised the cuts were likely higher under the current proposal.
ElevatingHome members—37 home health care providers spread across the country and ranging in size and mission, from for-profit to non-profit—looked at their claims from July 2017 and ran them under the groupings model . Instead of the estimated 4.3% average cut in payments, as predicted by CMS in its proposal, agencies saw an average payment reduction of 17% in their analysis.
“CMS says it’s 4.3% and $950 million [in cuts],” Joy Cameron, vice president for policy and innovation at ElevatingHome, told Home Health Care News. “Everyone is doing the mental math, [asking] can we sustain a 5% cut? And when they actually saw how it stratified out and the cuts on some of the type of work they do and are heavily dependent on, they were getting creamed.”
The grouping model also proposes to switch the current 60-day episode of care to 30 day periods of care. In its proposal, CMS stated that 25% of home health episodes could be completed in a single, 30-day episode.
However, providers found that between 36% and 37% of their July claims fell into the new 30-day limitations, despite claims that the new model would redistribute payments around patient needs. Providers could see a significant portion of their claims halved into a 30-day episode of care, further reducing their payments—even for patients currently under longer periods of care.
“This is a myth [the model] was tied to the patient,” Cameron said. “A different look at the whole patient [reveals] significant disappointments.”
In addition, the model is likely to reduce payment related to behavioral health services and for providers that receive more referrals from community-based sources, such as primary care physicians rather than hospitals, according to Cameron.
Because the HHGM proposal was released with the 2018 prospective payment system (PPS) updated, CMS only has until November 1 to finalize the rule. For every day the finalized rule is late past Nov. 1, implementation will be pushed back in 2018, according to Cameron. As a result, it’s possible that CMS could parse out the 2019 groupings model portal from the 2018 payment reduction to ensure the rates go into effect on time in 2018.
“The quickest and easiest thing for [CMS] to do is to pull out HHGM,” Cameron surmised.
However, what CMS will do is still up in the air.
Other industry groups have stressed to the agency that the groupings model is untested, and the industry needs time to give its input. The proposal was posted to the Federal Register in July, and the public comment period, which recently closed on September 25, garnered more than 1,300 comments.
Written by Amy Baxter
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