In the News

Top 10 Healthcare Industry Predictions For 2024

Forbes / By Sachin H. Jain
 
The Tofurkey’s been cooked and Black Friday sales have passed, which means it’s time for my annual forecast about what the year 2024 will hold for the healthcare industry.
 
To divine my predictions, I consulted a range of industry insiders, journalists, experts, psychics, shamans, and palm readers (phrenology anyone?).
 
The predictions below—delivered in high-resolution and with a money-back guarantee—touch politics, managed care, big pharma, artificial intelligence, academic medicine, and other arenas.
In sum, they lead me to predict that 2024 will be a year of major industry change.
Here’s what I believe the year has in store for us:
 
1. Presidential candidates will largely be silent on healthcare.
 
Nikki Haley gave a nod to Medicare Advantage in a recent Republican debate, but in general healthcare will take a back seat to other topics (Ukraine, the Middle East, and the economy) in the coming presidential election. Vivek Ramaswamy has experience as a health industry executive and could make healthcare a focus of his campaign, but so far he’s shown more interest in discussing other topics, including international affairs and his physician wife’s marksmanship skills. To be fair, the most significant underlying issues facing the healthcare industry are wonky and unlikely to capture the public imagination. If healthcare does come up, expect it to be addressed superficially, hyperbolically and with little of the nuance this important subject deserves.
 
2. Mega-mergers are coming back.
 
After a few years of quiescence, all signs point to mega-mergers reappearing on the horizon. A few weeks ago, Reuters reported that that Cigna is considering selling off its Medicare Advantage business. The news left a lot of people scratching their heads. But it makes perfect sense. Selling its Medicare Advantage business—likely to a cash-rich regional or national health plan—enables Cigna to pursue a merger with another national player with a strong footprint in government programs—think Humana and Centene—free and clear of anti-trust issues. In the year ahead, look for other big national health plans such as Elevance and Molina to follow in Cigna’s path with their own follow-on moves. And don’t forget about smaller regional plans, who will continue to shore up their competitive positioning in the increasingly consolidated landscape of national giants.
 
3. Medicare Advantage growth will slow.
 
Last year I predicted that there would be continued backlash against Medicare Advantage. (To get an idea of the arguments against the program, check out my recent debate with Richard Gilfillan, one of the program’s fiercest critics, on the main stage at the HLTH Conference.) I anticipate that criticism of the program—now spilling into mainstream consumer-facing media—will affect enrollment rates. In addition, there are some early signals that the market may have reached a saturation point. Those who desire Medicare Advantage likely have already chosen it; those who haven’t already chosen it will not.
 
While the Medicare Advantage program is certainly in need of a refresh (as I’ve described in previous columns),the legacy fee-for-service Medicare program is in even greater need. Fee-for-service Medicare still charges older adults high co-insurance rates for most services and lacks dental, vision, and hearing coverage. Medicare was intended by President Lyndon Johnson to provide older adults with a degree of security against bankruptcy from medical costs. The legacy program—as it has evolved—fails miserably to do so—and all the scrutiny on Medicare Advantage is giving traditional Medicare’s shortcomings far too great a pass…

Read Full Article (Forbes offers 4 free articles outside of subscription)

 

Update to Components Regarding Life Time, Inc.

Dear Component Leaders,

Term and title protection have been foundational to the physical therapy profession for most of its history. Use of the term physical therapy and the ability to call oneself a physical therapist are regulated by state boards in all U.S. jurisdictions and holds an individual accountable for recognized practice through licensure. This licensure standard provides individuals, who achieve licensure, with the ability to use the terms and credentials associated with this achievement and its associated accountability. This public policy is essential for public protection and consumer recognition. It is not uncommon for entities to attempt to use the terms and title of associated credentials to achieve greater recognition or to market their services to the public as being similar or synonymous with the privilege and accountability that is associated with these terms, title, and credentials. 

 Recently, the importance of term and title protection has been compromised by digital health entities that sought to provide coaching services under the misrepresentation of the services as physical therapy. APTA has engaged in efforts to ensure these digital companies meet recognized legal requirements and ensure public protection to correctly identify care when provided by a regulated and accountable health care profession. In addition, a national fitness chain, Life Time Inc., has launched a program that utilizes the term "DPT" as part of their "Dynamic Personal Training" program in a fashion that APTA believes is inappropriate, compromises public trust, and trades on the professional reputation and creditability of the physical therapy profession. 

 APTA has been engaged in efforts to prevent Life Time, Inc. from registering and using the term DPT as a trademark or part of a trademark that is deceptive or deceptively misdescriptive of its services to the relevant public as well as efforts to ensure use of the term DPT does not conflict with or violate state licensure laws and enforcement. 

 As a leader in the physical therapy community, APTA wanted to provide you with a summary of actions that APTA has pursued collectively and independently. We are committed to protect the use of DPT for consumers and for the profession.

Timeline of Action

December 15, 2022 – APTA sent correspondence to the CEO of Life Time, Inc. outlining our concerns with their use of the initials DPT and highlighting the potential violation of state law. APTA offered to meet to discuss our concerns with Life Time. 

May 17, 2023 – APTA, though our legal counsel, filed an initial 30-day request for extension of time to oppose Life Time, Inc.'s trademark application for DPT DYNAMIC PERSONAL TRAINING and design.

June 14, 2023 – APTA, though our legal counsel, requested a further 60-day extension of time to oppose Life Time, Inc.'s trademark application.

October 10, 2023 – Life Time, Inc. responded that they do not believe the DPT – Dynamic Personal Training program trademark is confusing or misleading to the public, and they declined to make modification to the trademark or use of DPT – Dynamic Personal Training (Letter from Faegre Drinker Biddle & Reath LLP – counsel to Life Time, Inc.).

October 16, 2023 – APTA filed trademark opposition with the U.S. Patent and Trademark Office. The opposition proceeding was instituted and is pending.

Actions that Components Can Take

  • Report suspected violations of your state's title protection law to your state licensure board. The use of the term DPT, especially when used prominently or in isolation from the dynamic personal training program, could potentially be a violation of state law. A recent survey by APTA State Affairs shows that 31 states and D.C. have explicit title protection for "DPT" while many other states have implied protection. View contact information.

  • Engage consumers that were misled by this program using the term DPT to market a personal training program as a physical therapy service or in connection with a physical therapy service. These consumers can report their concerns to state agencies or to the Federal Trade Commission. 

APTA will continue to pursue appropriate action to prevent the trademark use and registration of the term DPT by Life Time, Inc. when this credential and identification has been a protected part of the title protections afforded in state licensure law governing physical therapists. APTA will also seek efforts with Life Time, Inc. to create a program and serve their members with high quality personal training that is easily identifiable and clear to consumers and does not create confusion with a recognized and licensure health care profession, service and standard.

APTA will provide additional updates as they become available. If you have any questions or concerns, please feel free to contact the undersigned at APTA.

Sincerely,

Justin Moore, PT, DPT
Chief Executive Officer
American Physical Therapy Association

 

MedPAC Draws Fire with Draft Recommendations for Massive Home Health Cut, Hospice Rate Freeze

McKnight’s Home Care | By Adam Healy
 
The Medicare Payment Advisory Commission offered initial recommendations for Congress to cut home health reimbursement by 7% and pause hospice payment updates in 2025. 
 
“The 2022 [home health] margins remain above 20%, higher than the long-run average of 16.8% since 2001,” Evan Christman, senior analyst at MedPAC, said during last Friday’s public meeting, according to a transcript. “Overall, these margins indicate that Medicare fee-for-service continues to pay well in excess of cost.”
 
Part of the reason home health agencies reportedly saw margins of 22.2%, on average, according to Christman, is a decline in the number of visits per 30-day period. Since the implementation of the Patient-Driven Groupings Model in 2020, these visits have declined more than 15%; between 2021 and 2022, visits per 30 days declined 3.5%. 
Home health advocates were quick to dispute MedPAC’s claims.
 
“There are many shortfalls in MedPAC’s home health margins report — starting with the fact that MedPAC’s analysis only captures a declining fraction of the Medicare home health population, ignoring that overall margins are low,” Joanne Cunningham, chief executive officer of the Partnership for Quality Home Healthcare, said in a statement. “Additionally, relying on incomplete, poor-quality data and an opaque methodology runs the risk of dangerously misleading policymakers who rely on MedPAC to inform their decisions.”
 
The Partnership and National Association for Home Care & Hospice cited poor methodology and data in the recent home health final rule, which contained a Medicare cut related to PDGM. 
 
MedPAC: No hospice payment update
 
MedPAC also recommended that Congress eliminate any payment updates for hospice providers in 2025. The hospice program, according to MedPAC principal policy analyst Kim Neuman, shows signs that its current payment rates are sufficient to sustain quality and growth.
“Indicators of payment adequacy are favorable,” Neuman said. “The supply of providers continues to grow. The share of decedents using hospice, the number of hospice users and total days of care increased. Length of stay also increased. In-person visits per week increased slightly, and marginal profit was 17%.”…

Read Full Article

 

National Health Expenditures 2022 Highlights

CMS.gov

U.S. health care spending grew 4.1% to reach $4.5 trillion in 2022, faster than the increase of 3.2% in 2021, but much slower than the rate of 10.6% in 2020. The growth in 2022 reflected strong growth in Medicaid and private health insurance spending that was somewhat offset by continued declines in supplemental funding by the federal government associated with the COVID-19 pandemic. 

In 2022, the insured share of the population reached 92% (a historic high). Private health insurance enrollment increased by 2.9 million individuals and Medicaid enrollment increased by 6.1 million individuals. In 2022, 26.6 million individuals were uninsured, down from 28.5 million in 2021 (a difference of 1.9 million individuals).

Gross domestic product (GDP) continued to increase at strong rates of growth in both 2021 and 2022, increasing 10.7% and 9.1%, respectively. With a lower rate of health care spending growth of 4.1% in 2022, the share of GDP devoted to health care fell to 17.3% in 2022, lower than both the 18.2% share in 2021 and the highest share in the history of the National Health Expenditure Accounts of 19.5% in 2020. During 2016-19 the average share was 17.5%.

Federal COVID-19 supplemental funding to the health sector through the Provider Relief Fund and the Paycheck Protection Program was highest during the initial year of the pandemic and continued to affect health care expenditures in 2021 and 2022, although at reduced levels. Funding to the health sector through these programs was $174.6 billion in 2020, but just $2.0 billion in 2022.

Health Spending by Type of Service or Product.

  • Home Health Care (3% share):  Spending for services provided by freestanding home health care agencies increased 6.0% in 2022 to $132.9 billion, accelerating from growth of 0.3% in 2021. Private health insurance, out-of-pocket, and Medicaid home health spending contributed to the faster growth, while Medicare spending growth for home health care services slowed…

Read Full Press Release

 

The HHVBP Changes Experts Believe Home Health Providers Are ‘Overlooking’

Home Health Care News | By Patrick Filbin
 
Several of the biggest changes in the U.S. Centers for Medicare & Medicaid Services’ (CMS) CY 2024 final home health rule deal with the Home Health Value-Based Purchasing (HHVBP) model.
 
At face value, it may seem like the HHVBP process is being simplified in the way providers fill out OASIS forms.
 
However, there’s more to it than just that.
 
“What is true today is not what’s going to be true with the final rule,” Cindy Krafft, owner of K&K Health Care Solutions, said during a MedBridge webinar on Tuesday. “I do believe that many people were so concerned about the reimbursement piece that there was not enough feedback in the open comment period about some of these other things.”
 
For instance, Krafft pointed out the HHVBP change which saw a total normative composite turn to a discharge functional score.
 
Essentially, CMS will evaluate home health agencies with an emphasis on the functional status of patients at the time of discharge from their agencies, as opposed to a comprehensive measure of various factors — including patient outcomes, processes of care and patient experience.
 
“That sounds like a great concept, but we can’t oversimplify it,” Krafft said.
 
For example, OASIS measures like eating, oral hygiene, toileting hygiene and a number of physical functionality scores are included in the new calculation.
 
What’s missing, Krafft pointed out, is bathing and dressing.
 
“There are some pretty heavy-hitting activities related to function that we have been focused on — and rightfully so — for a very long time,” Krafft said. “Even before OASIS, we knew our folks had to be able to manage bathing and dressing and meal prep and all of those things to be able to have patients be safe at home. But they’re not on this list.”
 
The reason why the list is shortened is related to the Improving Medicare Post-Acute Care Transformation Act, also known as the IMPACT Act.

Read Full Article

 
<< first < Prev 1 2 3 4 5 6 7 8 9 10 Next > last >>

Page 10 of 101