In the News

How Home Health Providers, Payers Are Adapting to New Referral Patterns

Home Health Care News | By Patrick Filbin

Prior to the COVID-19 pandemic, it wasn’t uncommon for home health agencies and other post-acute care providers to beg hospitals to be a part of their post-acute networks.

Three years later, that’s generally not the case. The referral patterns in home-based care have seen a radical shift, and agency leaders are still adjusting to those changes and making adjustments on the fly.

“We were used to hearing from hospitals that we had to have a five star rating, have to have a medical director and all these other ancillary services,” Health Dimensions Group (HDG) CEO Erin Shvetzoff Hennessey said at Aging Media Network’s Continuum conference in December. “Now, the hospitals are realizing that the patients that they need help discharging don’t always fit into this five star model. These are difficult patients and sometimes difficult patients result in survey activity that doesn’t move you into the five star category. So, if you start to create this preferred provider network, it gets a little too preferred — and they need post-acute care to take these patients and to clear the hospital out.”

HDG operates a portfolio of 25 senior living communities across eight states. It also has a major contingent of skilled nursing properties.

Hennessey said that, because patients being discharged from the hospital are more complicated than they were before, two different referral groups are starting to emerge.

On one side, there are the five star referral partners who meet all the certain metrics that hospitals like to see.

“And then there’s this off-to-the-side network where we know that discharge planners are really connecting with post-acute,” Hennessey said. “These are the providers saying yes. Now we have this formal network and this informal network that’s actually getting patients moved.”

Referrals to home health care have been on a steady increase over the last three years. At the same time, providers are rejecting them at an unprecedented rate

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Medicare Advantage Analysis Sparks Infighting at MedPAC Meeting

Fierce Healthcare | By Noah TongJan
 
A MedPAC meeting on the status of Medicare Advantage held Friday began with numbers on enrollment and insights into coding diagnoses before devolving into contentious debate over the quality of the report and whether the program is a good development for healthcare in the country.
 
Brian Miller, an assistant professor of medicine at John's Hopkins University, was at the center of complaints toward the status report compiled by policy analysts, arguing that the report only highlighted the negatives of the program and that past suggestions of his have not been taken into consideration.
 
Because Miller believed the report was decidedly anti-Medicare Advantage, he challenged the analysts to name three positive things about the program, calling into question the objectivity of the report. They responded that they strive for balance, and the commission, which is a nonpartisan independent agency that advises Congress on Medicare, has a long history of supporting private plans in the Medicare program. When chair Michael Chernew, professor of healthcare policy at Harvard, attempted to move along the conversation to the next commission member, Miller persisted.
 
"I think this is important for the public record because it gets to how balanced we are and how we approach programs, and this didn't really feel very balanced," he said. "There are plenty of bad things definitely that need to be improved ... I think it's really important again that it's a neutral thoughtful policy analysis."
 
Better Medicare Alliance, an advocacy organization in support of MA, stated they have "concerns" about MedPAC's methodology in the recent report. They highlight how 99% of patients have enhanced supplemental benefits in plans with $18 premiums.
 
"Relative to beneficiaries in fee-for-service Medicare, Medicare Advantage beneficiaries are lower-income, more diverse medically and socially complex and increasingly live in rural areas," said President and CEO Mary Beth Donahue in a statement shared with Fierce Healthcare following the hearing.
 
Over the course of the more than two-hour discussion, many members pushed back against the claims, praising the analysts' comprehensive look at Medicare Advantage in the report…

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Doctor and Clinician Utilization (Procedure Volume) Data Now Available on Medicare.gov Compare Tool

The Centers for Medicare & Medicaid Services (CMS) added utilization data, specifically procedure volume, for the first time on the Medicare.gov compare tool’s profile pages for doctors and clinicians. The procedures initially added to profile pages were performed by doctors and clinicians for Original Medicare and Medicare Advantage patients in the last 12 months, after allowing a three-month claim processing period (for example, claims for dates of service occurring between June 1, 2022 through June 30, 2023 that were processed by September 30, 2023).

Utilization data was first published only in a downloadable format in late 2017. This information is a subset of the “Medicare Physician & Other Practitioners – by Provider and Service” dataset, and is currently published in the Provider Data Catalog (PDC). A procedure volume data file is now available and includes the procedure category information currently publicly reported on the compare tool on Medicare.gov profile pages for doctors and clinicians.

The initial release of procedure volume data on doctor and clinician profile pages includes 12 procedures (additional procedures will be added periodically, as feasible):

  1. Hip replacement
  2. Knee replacement
  3. Spinal fusion
  4. Cataract surgery
  5. Colonoscopy
  6. Hernia repair – groin (open)
  7. Hernia repair (minimally invasive)
  8. Mastectomy
  9. Coronary artery bypass graft (CABG)
  10. Pacemaker insertion or repair
  11. Coronary angioplasty and stenting
  12. Prostate resection

For more information, access the “Utilization (Procedure Volume) Data Published on the Compare Tool on Medicare.gov” fact sheet (PDF, 195 KB) on the Care Compare: Doctors and Clinicians Initiative page.

If you have any questions about public reporting for doctors and clinicians on the Medicare.gov compare tool, contact the Quality Payment Program (QPP) Service Center by email at [email protected], by creating a QPP Service Center ticket, or by phone at 1-866-288-8292 (Monday-Friday, 8 a.m. - 8 p.m. ET).

To receive assistance more quickly, especially during busier periods such as the submission window, please consider calling during non-peak hours — before 10 a.m. and after 2 p.m. ET.

People who are deaf or hard of hearing can dial 711 to be connected to a Telecommunications Relay Services (TRS) Communications Assistant.

 

DOL Issues Final Rule on Independent Contractors, Effective March 11

SESCO Management Consultants

The U.S. Department of Labor (DOL) has issued a final rule to clarify who is an independent contractor under the Fair Labor Standards Act (FLSA).

The final rule also rescinds a 2021 rule in which two core factors—control over the work and opportunity for profit or loss—carried greater weight in determining the status of independent contractors. The 2021 rule, which is still in effect, made it easier for employers to classify workers as independent contractors, rather than as employees.

The final rule will take effect on March 11, 2024.

The final rule returns to a more employee-friendly standard. Under the final rule, employers would use a totality-of-the-circumstances analysis, in which all of the factors do not have a predetermined weight. The six factors the DOL would look at are:

Opportunity for profit or loss. If a worker can set or negotiate his pay, accept or decline jobs, choose the order or time of performance, engage in marketing to expand the business, and hire others, purchase materials or otherwise invest in the business, the worker is more likely to be an independent contractor. However, deciding to do more work or accept more jobs is not indicative of contractor status. It is unclear how the ability to "accept or decline jobs" indicates contractor status, while the decision to "take more jobs" does not.

Investments by the worker and the employer. Investments that are "capital or entrepreneurial" in nature, such as those increasing the worker's ability to do different types or more work, reducing costs or extending market reach are indicative of contractor status. However, investing in tools to do the job indicates employee status. It is not clear how this factor would be applied in jobs that do not require any significant investment beyond a computer and internet connection. This factor also embraces the idea that the worker's level of investment should be compared to the business' investments. The utility of the relative-comparison factor is at best unclear and at worst illogical, as nearly every business will have invested more overall than any individual worker, and it would change the nature of the employment relationship based not on the worker's activities or the work done, but simply on the size of the business engaging the worker.

Degree of permanence of the work relationship. When the working relationship is indefinite or continuous, it indicates employee status. When the work is definite in duration, nonexclusive, project-based, or sporadic "based on" the worker providing services to other businesses, it is indicative of contractor status. When the work is project-based or sporadic for some other reason (such as the nature of the business), then it does not indicate contractor status.

Nature and degree of control. This factor looks at various indicia of control over the work and the economic aspects of the relationship. Importantly, control that is merely reserved, but not exercised, still counts as "control." Also notable is the DOL's statement that control exercised to ensure compliance with "legal obligations, safety standards, or contractual or customer service standards may be indicative of control." Prohibiting a subcontractor from engaging in unlawful discrimination, requiring it to follow safety rules or flowing down compliance clauses, would therefore appear to undermine contractor status.

Extent to which the work performed is an integral part of the employer's business. This factor weighs in favor of employee status when the work is "critical, necessary, or central to the employer's principal business." It is unclear what role a contractor could play that would not be "critical, necessary, or central to the employer's business." For instance, external accounting and marketing functions, both historically areas for independent contractors, would seem to be both "critical" and "necessary."

Skill and initiative. This factor looks at whether the worker uses "specialized skills" in performing the work, and whether those skills "contribute to business-like initiative." Being highly skilled in the substance of a particular field (such as engineering, journalism, or hospitality) does not seem to be the kind of "skill" contemplated. Rather, skill in running an independent business is what matters.

The DOL then includes a catch-all provision stating that additional factors may be relevant "if the factors in some way indicate whether the worker is in business for themself, as opposed to being economically dependent on the employer for work."

[Department of Labor’s updated Independent Contractor test As the March 11 effective date approaches, the DOL has issued FAQs offering guidance]

If employers have any questions or concerns, we recommend they contact SESCO Management Services to ensure compliance. For assistance, contact them at 423-764-4127 or by email at [email protected]

 

Report: Home Health Spending in October Continued to Outpace Other Healthcare Segments

McKnight’s Home Care | By Adam Healy
 
Year-over-year healthcare spending was fastest within the home health sector for the third straight month, according to a Health Sector Economic Indicators brief for October by nonprofit research and consulting firm Altarum.
 
Healthcare spending overall grew 6% year over year during October 2023, representing 17.4% of the national gross domestic product, according to the report. At the same time, consumers’ utilization of healthcare services has continued to outpace the price of those services. The Health Care Price Index estimated a 2.9% year-over-year increase in November, while utilization grew by 4.8%
 
Home health and personal care again dominated spending growth. October saw a 2.9% rise in personal care spending, driven by utilization rates rather than price increases. The fastest-growing category was home healthcare, which saw a 13.5% increase year-over-year. Prices for home health services were also among the fastest-growing at a rate of 4.3%.
 
The healthcare industry overall added 76,800 jobs in November, which tied July 2023 for the most jobs added in a month compared to the previous year. This constituted roughly 35% of all the jobs added to the United States economy during the month, which added just under 199,000. Still, economywide job growth in November — 199,000 — fell behind the 12-month average of 232,600. Unemployment dropped slightly to 3.7%.
 
Nursing and residential care facilities brought in the most new workers, with 17,300 jobs added in November. Nursing homes followed with 5,700 new jobs…

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