2023 RIHC Home Care Chartbook, Co-Sponsored by NAHC

The Institute is excited to announce the 2023 RIHC Home Care Chartbook is now available online! 

Highlighted by data on Medicare Advantage home health patients, workforce trends, and more, the Chartbook is an invaluable tool for understanding the role home care plays in the U.S. healthcare landscape. 

Released annually, the Chartbook, co-sponsored by the National Association for Home Care & Hospice (NAHC), and compiled and charted by KNG Health Consulting LLC, summarizes and analyzes statistics on home health from a range of government sources. The Chartbook offers a glimpse of home health patients, the home health workforce, organizational trends, and the economic contribution of home health agencies. The Chartbook includes updated statistics from the Bureau of Labor Statistics, the U.S. Department of Commerce, Medicare Cost Reports, Home Health Compare, Medicare fee-for-service claims, the Medicare Current Beneficiary Survey, and other data from CMS. 

We would like to thank 2023 Chartbook sponsor NAHC for their continued support of the Institute and the Chartbook. Learn more about NAHC at www.nahc.org.

A copy of the 2023 RIHC Home Care Chartbook is available here. 

Please join us for a webinar with the team from KNG, along with our co-sponsors at NAHC, on Wednesday, December 6th at 2 pm ET. Register now here.

For more information on the Chartbook, please reach out to the Institute's Executive Director, Jen Schiller, at [email protected] or (771) 203-0595.

Practice Committee Publishes New Medication Reconciliation Resource

Medication reconciliation is an important aspect of the initial and ongoing assessment for a patient receiving home health physical therapy. Medication reconciliation refers the process of creating the most accurate list of all medications a patient is taking, including drug name, dosage, frequency, and route and comparing that list against the admission, transfer, and/or discharge orders, with the goal of providing a correct list of medications to the patient at all transition points. Medication discrepancies frequently occur during care transitions from hospital to home. These discrepancies place patients at risk for adverse drug events (ADEs). Medication reconciliation is essential in managing adverse drug events and improving drug safety in older adults. It can be difficult to obtain a complete list of medications from a home health patient, and accuracy is dependent on the patients or caregiver’s ability and willingness to provide this information.

The “Medication Reconciliation in Home Health Physical Therapy” resource covers challenges in home health in reconciling medications, gives tips questions to ask patients and care givers to enhance the reconciliation process, and reviews methods to breaking barriers to medication reconciliation in home health.

Click Here to Download Resource

CMS Final Rule Reins in 2024 Rate Reduction, But Brings Big Cuts Beyond

HomeCare News

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) issued its 2024 Home Health Prospective Payment System Rate Update final rule on Nov. 1, landing on more moderate cuts than initially proposed but still enacting rate reductions beginning in 2025 that would present “serious concerns for the home health community,” according to the National Association for Homecare and Hospice.

The final rule calls for a -2.890% permanent adjustment in payment rates to home health agencies in calendar year 2024, half of the full permanent adjustment of -5.779%. The proposed rule called for a slightly lower overall permanent adjustment of -5.653%. CMS said that because the new rule only calls for half of the full permanent adjustment to go into effect in 2024, Medicare payment to home health agencies will increase by .8%, rather than the original 2.2% decrease initially proposed.

“This halving of the permanent adjustment is in response to commenter concerns about the magnitude of a single-year significant payment reduction,” CMS wrote in its announcement of the rule. “CMS will have to account for the remaining permanent adjustment not applied in CY 2024, and other potential adjustments needed to the base payment rate, to account for behavior change based on analysis at the time of future rulemaking.”

But NAHC said the cuts would still come to 6.533% over 2023 and 2024—with more to come in future years.

“We continue to strenuously disagree with CMS’s rate-setting actions, including the budget neutrality methodology that CMS employed to arrive at the rate adjustments,” said NAHC President Bill Dombi. “We recognize that CMS has reduced the proposed 2024 rate cut. However, overall spending on Medicare home health is down, 500,000 fewer patients are receiving care annually since 2018, patient referrals are being rejected more than 50% of the time because providers cannot afford to provide the care needed within the payment rates, and providers have closed their doors or restricted service territory to reduce care costs. If the payment rate was truly excessive, we would not see these actions occurring.”

“The fatally flawed payment methodology that CMS continues to insist on applying is having a direct and permanent effect on access to care,” Dombi continued. “When you add in the impact of shortchanging home health agencies on an accurate cost inflation update of 5.2% over the last two years, the loss of care access is natural and foreseeable.”

NAHC is currently suing CMS, saying the basis for its payment assumptions is flawed, and also pushing Congress to pass the bill S 2137, which would block the final rule.

“We now implore Congress to correct what CMS has done and prevent the impending harm to the millions of highly vulnerable home health patients that depend and will depend in the future on this essential Medicare benefit,” Dombi said. “We urge the Congress to support this bill and enact it into law before the end of the year. The 2024 rate cuts must not take effect” Dombi added.

The new rule also finalizes CMS’s proposals to:

• Rebase and revise the home health market basket
• Revise the labor-related share
• Recalibrate case-mix weights under the Patient-Driven Groupings Model (PDGM)
• Update low utilization payment adjustment thresholds, functional impairment levels and comorbidity adjustment subgroups for 2024
• Codify statutory requirements for disposable negative pressure wound therapy
• Establish payment rules for lymphedema compression treatment and home intravenous immune globulin

The rule also updates requirements for how often and when providers of durable medical equipment prosthetics, orthotics and supplies (DMEPOS) must contact beneficiaries before dispensing resupply items…

Read Full Article

Find the final rule at: https://www.federalregister.gov/public-inspection/2023-24455/medicare-program-calendar-year-2024-home-health-prospective-payment-system-rate-update-quality

Read a fact sheet on the rule at: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-final-rule-cms-1780-f

Home Health Agencies Made The HHVBP Model Demonstration A Resounding Success

Home Health Care News | By Patrick Filbin
 
In the first six years of the Home Health Value‐Based Purchasing (HHVBP) Model demonstration, the nine participating states saved Medicare $1.38 billion, a 1.9% decline relative to the 41 non‐HHVBP states.
 
That’s according to a new study from the U.S. Centers for Medicare & Medicaid Services (CMS) that evaluated the first six years of HHVBP before the national expansion at the beginning of 2023.
 
The HHVBP Model was implemented to incentivize home health agencies to improve the quality of care they provide to Medicare beneficiaries.
 
The goal of the model is to link Medicare reimbursement to the quality of care, rather than just the quantity or volume of services.
 
CMS first adjusted Medicare payments by up to 3% in 2018, using home health agencies’ 2016 Total Performance Score (TPS). Payment adjustments increased each year, peaking at up to 7% in 2021.
 
With the nine-state trial in the rearview mirror, CMS’ study shows both positives and some negatives, with the HHVBP model.
 
While saving Medicare over $1 billion, providers under the HHVBP pilot also reported reductions in unplanned hospitalizations, skilled nursing facility use and gains in functional status for patients like mobility and self‐care.

The reductions in Medicare spending were largely driven by reductions in skilled nursing facility services ($235.8 million decrease), inpatient hospitalization stay ($807.0 million decrease) and home health spending ($283 million decrease).
 
Home health agencies in HHVBP states also received higher TPS scores than agencies in non‐HHVBP states for each of the six years.
 
Agencies reported modest improvement in patients’ mobility, the management of medications and self‐care due to the value-based model. A higher number of patients were discharged into the community rather than institutional care in the HHVBP model.
 
Room for improvement
 
While the value-based model showed improvements in nearly every OASIS-based quality measure, agencies did report an increase in outpatient emergency department (ED) visits.

“We examined additional utilization measures and found HHVBP led to cumulative declines in SNF use and ED use followed by inpatient admission, but there was no cumulative impact of HHVBP on overall ED use,” CMS wrote in its study. “Together, these results suggest that the increase in outpatient ED use attributed to HHVBP is related to the reduced likelihood of ED use followed by an inpatient hospital stay.”