In the News

With Home Health Rule Unveiled, All Eyes are on HHVBP

McKnight's Home Care | By Liza Berger

A big exhale seemed to sound from the industry last week after the release of the final Medicare home health rule. No question the measure was imperfect, but it helps clear the way for firms to make plans and prepare for other regulatory changes. And of the latter, there are some big ones, including the start of the Home Health Value-Based Purchasing (HHVBP) model, which goes live nationally Jan. 1.

Not unlike the home health rule, there is much anticipation for the HHVBP model, which is based on how well an organization ranks compared  to its peers. Under the expanded initiative, home health agencies receive adjustments to their Medicare fee-for-service payments based on their performance against a set of three quality measures relative to their peers’ performance: Data from Outcome and Assessment Information Set (OASIS), completed Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) surveys and claims-based measures.

The Centers for Medicare & Medicaid Services has been bullish on this model ever since it tested it in nine states starting in 2016. The original model resulted in an average of 4.6% improvement in HHAs’ total performance scores and an average savings of $141 million to Medicare. Evaluation of the original model also found reductions in unplanned acute care hospitalizations and skilled nursing facility (SNF) stays, resulting in reductions in inpatient and SNF spending.

Understandably, the home health industry has voiced reservations toward the national expansion of HHVBP. Due to feedback from provider groups such as the National Association for Home Care & Hospice, CMS delayed the start of HHVBP to 2023. In the recent home health rule, CMS established 2022 as the baseline line. 2025 is the first payment year for the program.

The program symbolizes the ethos of healthcare at the moment: paying for value as opposed to volume, focusing on quality and savings, and keeping people out of the hospital. As companies and consultants continue to remind us, if you are not yet on board the value-based care bus, it’s time to purchase a ticket. Learn more about HHVBP  and how to prepare for it.


CMS Care Compare to Offer More New Information on Home Health-Physician Relationships

Home Health Care News | By Andrew Donlan

Care Compare – the all-in-one search tool for consumers seeking home health, hospice and other Medicare-reimbursed health care services – will now include new information on providers’ relationships with doctors and clinicians.

The U.S. Centers for Medicare & Medicaid Services (CMS) announced the update on Monday.

According to CMS, the new update is meant to “provide additional information to support patients and caregivers as they make health care decisions.” The update, the agency noted, will also offer “information about clinicians who aren’t affiliated with a hospital but work in other types of health care facilities.”

Specifically, the update will be found under the “Doctors and Clinicians” section on Care Compare.

In addition to showing Medicare beneficiaries and their families which home health and hospice providers physicians are linked to, the update will include details on affiliations with skilled nursing facilities (SNFs), long-term care hospitals (LTCHs), in-patient rehabilitation facilities (IRFs) and dialysis facilities.

Broadly, the update is part of CMS’ effort to make Care Compare more transparent and seamless across the major health care settings.

Prior to the Monday announcement, one of the most recent changes to Care Compare was adding Medicare-certified nursing home ownership data to the tool. In April, CMS also released data publicly – for the first time ever – on mergers, acquisitions, consolidation and changes of ownership for hospitals and nursing homes enrolled in Medicare.

“We’re taking another major step forward in improving transparency in health care,” CMS Administrator Chiquita Brooks-LaSure said at the time.

Adding insight on physician and clinician affiliations comes roughly 2 years after CMS consolidated all its different “Compare” tools into today’s one-stop shop. Originally, there were seven different Compare sites for the various Medicare-reimbursed health care settings.

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After Hospital Discharge, Slow Home Health Care Initiation Increases Risk of Rehospitalization

American Journal of Managed Care | By Jared Kaltwasser

Patients discharged from the hospital are at a higher risk of rehospitalization if they experience a delay in postdischarge home health care initiation, according to a new study.

The study, published in Journal of the American Medical Directors Association, shows the risk of a rehospitalization or emergency department (ED) visit jumps by 12% when patients wait more than 2 days for their at-home care to start.

More than 6 million Americans receive home health care each year, noted the study’s authors. In many cases, those home visits follow discharge from a hospital. Home health care providers can perform a range of services, including clinical assessments, wound management, and medication reconciliation, the authors said. Previous research shows that home health care visits following hospitalization can reduce the risk of readmission, especially for certain conditions, such as sepsis and heart failure.

CMS requires that initial at-home patient visits take place within 48 hours of referral or of the patient’s return home, unless otherwise stated by the patient’s physician. However, the investigators said no study has yet looked at whether the timing of such visits has an impact on patient outcomes.

They decided to examine the records of an urban home health care agency in the northeastern United States in order to see whether the agency’s success or failure in initiating care within 48 hours had a meaningful impact on patient outcomes.

The investigators analyzed a data set of 49,141 home health care visits received by 45,390 patients who were discharged from the hospital during 2019 and referred for at-home follow-up. They compared the timing of home health care initiation with 30-day hospitalizations and ED visits to see whether the timing affected outcomes and whether there were any disparities based on factors such as race/ethnicity, age, insurance type, and clinical status.

In total, about one-third of initial home health care episodes in the data set were delayed, meaning they did not happen within 48 hours. Previous research by the present study’s authors suggest that patients not answering the door or postponing visits were among the most common reasons for such delays.

Of those 34% of cases in which care was delayed, 14% of those delays resulted in a rehospitalization or ED visit within 30 days. And that translated into a 12% higher risk of rehospitalization or ED visit for patients whose home health care was not started within 2 days vs those who received timely initiation of home services.

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Guideline for Prescribing Opioids for Pain

Centers for Disease Control and Prevention

Pain affects the lives of millions of Americans every day and improving pain care and the lives of patients with pain is a public health imperative. The Centers for Disease Control and Prevention (CDC) is releasing updated and expanded recommendations for clinicians providing pain care for adult outpatients with short- and long-term pain. These clinical recommendations, published in the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, will help clinicians work with their patients to ensure the safest and most effective pain care is provided. The publication updates and replaces the CDC Guideline for Prescribing Opioids for Chronic Pain released in 2016.

“Patients with pain should receive compassionate, safe, and effective pain care. We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life,” said Christopher M. Jones, PharmD, DrPH, MPH, Acting Director of CDC’s National Center for Injury Prevention and Control.

The 2022 Clinical Practice Guideline addresses the following areas: 1) determining whether to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use.  The Clinical Practice Guideline supports the primary prevention pillar of the HHS Overdose Prevention Strategy – supporting the development and promotion of evidence-based treatments to effectively manage pain.

The guideline is a clinical tool to improve communication between clinicians and patients and empower them to make informed decisions about safe and effective pain care. The recommendations are voluntary and provide flexibility to clinicians and patients to support individualized, patient-centered care. They should not be used as an inflexible, one-size-fits-all policy or law or applied as a rigid standard of care or to replace clinical judgement about personalized treatment.

CDC followed a rigorous scientific process using the best available evidence and expert consultation to develop the 2022 Clinical Practice Guideline. An independent federal advisory committee, four peer reviewers, and members of the public reviewed the draft updated guideline, and CDC revised it in response to this feedback to foster a collaborative and transparent process. CDC also engaged with patients with pain, caregivers, and clinicians to gain insights and gather feedback from people directly impacted by the guideline. The expanded guideline aims to ensure equitable access to effective, informed, individualized, and safe pain care.

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RAISE Act Council Offers National Caregiver Support Strategy 

A 102-page report marks the RAISE Act Family Caregiving Advisory Council’s September completion of the first-of-its-kind National Strategy to Support Family Caregivers. The product of extensive deliberation and analysis of expert contributions, the report includes substantial background information on the current landscape of family caregiving, as well as many proposed federal, state and local actions in support of caregivers. The proposals are organized under five major goals: 

  • Improved awareness of and outreach to family caregivers; 
  • Inclusion of family caregivers in the care team; 
  • Services and supports for family caregivers; 
  • Financial and employment protections; and 
  • Data, research, and best practices.  

The ACL website provides access to the entire document and supporting materials. Comments from the public are encouraged through the deadline of November 30. 

Publication of the national strategy has been met by enthusiastic reactions across the caregiving spectrum, including the Family Caregiver Alliance (FCA). “We share the authors’ hope,” FCA stated, “that as the Strategy is implemented—and as the nation more fully comes to understand and respond to the challenges faced by family caregivers—society will embrace the cultural and policy shifts necessary to support them. As a result, over time, lawmakers likely will be called upon to propose legislative changes to better support family caregivers. This is a historic moment for family caregiving because, as the Strategy introduction states, ‘This is the first time that ideas from local and state agencies and nonprofit organizations are integrated with recommendations for the federal government in a combined initiative dedicated to family caregiving. The development of these lists also represents the first time that agencies across the federal government have formally worked together to coordinate family caregiver support planning.’”

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