Medicare Physician Fee Schedule Cuts Coming in January. Is Help on the Way?

APTA

A new bipartisan bill provides full relief to the 3.4% cuts, but nothing can happen until Congress comes back from recess.

Despite strong advocacy from APTA, the American Medical Association, and more than 100 other patient and provider groups, Congress is likely to leave Capitol Hill without addressing a 3.4% cut to payment under Medicare Part B, closing the last window that would've prevented the cuts from taking effect Jan. 1. With the cuts now almost certain to be implemented, the next opportunity to provide relief will come in January, when Congress must act on government funding by Jan. 17. Fortunately, groundwork has been laid for a needed change, thanks to a recently introduced APTA-supported bipartisan bill that would fully offset the reductions.

The bill, H.R. 6683, introduced in the U.S. House of Representatives, would provide full relief from the cuts, and make that relief retroactive to the Jan. 1 implementation date. APTA has joined with AMA and other provider groups to urge lawmakers to include the legislation in whatever package Congress adopts to fund the government in 2024, and the association is urging members and supporters to voice support for the bill with their lawmakers though the APTA Patient Action Center or Legislative Action Center. Both resources make the process fast and easy.

Support for the legislation in the House is growing. Recently, more than 190 representatives signed onto a letter urging congressional leaders to prevent the cuts, writing that "physicians and other healthcare providers, who are confronting inflationary pressures and workforce shortages, need Congress to prevent this cut, which will add significant burdens to the healthcare infrastructure and the communities they serve."

Read Full Article

Is AI Making Claim Denials in Error? What Does It Matter if We Don't Appeal?

APTA | By Wanda Evans, PT, DPT, MHS

These days, it's hard to escape the attention being paid to artificial intelligence, or AI. The technology is making its way into what seems like every corner of our lives, including in our professional capacities as PTs and PTAs, and in the ways payers make care decisions.

Unfortunately, it's not all good news: This year, two behemoth commercial payers, UnitedHealthcare and Cigna, were challenged with potential class-action lawsuits alleging misuse of AI in ways that negatively impacted patient care. In Cigna's case, the allegations are that the insurer relied too heavily on an algorithm that resulted in a high rate of claim denials. UnitedHealthcare is facing a similar allegation that its algorithm denied needed extended care for older adult patients.

Of course, media coverage of these suits focuses on the use of AI — and to a large extent, that makes sense. But for health care providers and patients, the real issue here isn't about the use of algorithms, no matter how sophisticated. The real issue is about the importance of appealing denials…

Read Full Article

NAHC President Offers Upbeat Forecast for Home Care in 2024

McKnight’s / By Adam Healy

Though providers weathered hardships from Medicare rate cuts to worker shortages in 2023, developments on the horizon give encouragement for home care’s future, according to William Dombi, president of the National Association for Home Care & Hospice.

“There is no shortage of innovations and reforms ongoing now,” Dombi said in a Thursday webinar hosted by healthcare technology firm Relias. He reassured providers: “You are all in the right place. The challenges will be there, but so will opportunities.”

Many of these innovations came in the form of successful payment or care delivery models that hit their strides during 2023. One of these, the Home Health Value-Based Purchasing Model, expanded on a national scale in January. It represented “one of the very few value-based programs that has been shown to work,” according to Dombi. Other positive developments include the ever-growing hospital-at-home program, advancements in telehealth services and strong Medicaid support for home- and community-based services.

Medicaid HCBS concern

Still home care initiatives such as Medicaid HCBS, one of the largest home care programs in the nation, Dombi noted, are facing challenges. The Medicaid Access Rule, proposed in May, would require 80% of Medicaid payments for homemaker, personal care and respite care services be used on worker compensation.

“If you’re a Medicaid provider, this is something to pay attention to,” Dombi said

Though the rule was designed with noble intentions, including alleviating home care workforce challenges, such stringent payment mandates could give providers cause for concern, he added. 

And while shortages may signal increased demand for home care services, staffing remains a top priority across the home care, hospice and healthcare industry at large.

“Demand and interest remains exceptionally high — higher than we have the supply,” Dombi noted. “Currently, the data is showing that more than half of all referrals to home health agencies are being rejected due to workforce shortages.” 

Recruitment and retention therefore should remain at the forefront for providers, as losing employees sacrifices time, money and even quality of care. But to reach these workforce goals, “better compensation starts with better payment rates,” Dombi asserted.

Strong congressional support

NAHC and other advocates made strong headway with congressional leaders in 2023, particularly through the introduction of the Preserving Access to Home Health Act of 2023 and the recent House passage of the Elizabeth Dole Home Care Act. In September, home care allies spoke out against erosion of the Medicare home health benefit before the Senate Finance Committee’s Subcommittee on Health Care, winning support from both sides of the aisle.

“We are seeing strong bipartisan support for home health services,” Dombi said. And while political bickering and sticker shock surrounding pricey legislation are eternal barriers to strong, consistent federal support for home care, the reality that older loved ones are in need of care “tends to bring the parties together,” he noted…

Read Full Article

Biden Administration Urges Judge To Throw Out NAHC’s Home Health Payment Lawsuit

Home Health Care News / By Andrew Donlan
 
In July, the National Association for Home Care & Hospice (NAHC) filed a lawsuit against the U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services over home health payment cuts. 
 
On Dec. 15, the Biden administration responded by asking a federal judge to throw out that lawsuit, in a move that NAHC considered a predictable outcome. 
 
“The government’s position in responding to the NAHC lawsuit, as set out in its December 15 brief, was fully expected,” NAHC President William A. Dombi said in a statement shared with Home Health Care News. “Virtually every lawsuit against Medicare includes an effort to dismiss the case on the grounds that the court does not have the power to adjudicate the complaints.”

The lawsuit, pertaining to CMS’ home health payment methodologies, was put forth when NAHC felt like it had “no other option left.” After continued advocacy in Washington, D.C., and attempts at legislation over the previous two years, NAHC felt legal means had to be pursued. 

In 2022, CMS finalized permanent cuts to home health payments. It did the same in 2023. 
 
HHCN has previously broken down some of the viable legal arguments against CMS’ continued cuts to home health payments. 
 
“We continued our conversations, discussions and advocacy with CMS in hopes of seeing something happening in the proposed rule that was issued last week,” Dombi said in July when the lawsuit was filed. “When that rule came out, CMS absolutely stuck to its position on the budget neutrality calculation methodology. It was decided that we really had no other option left to try to deal with that other than to go to court.”…

Read Full Article