President's Message

October 22, 2024

Let’s talk about service to APTA Home Health and your profession. Quite simply, we can not do the things that we do for you, our members, without the concerted efforts of the volunteers who lead our academy and the many more volunteers who participate on our various committees. These members give freely of their time and knowledge to provide you with engaging social media content, cutting edge clinical resources, strong advocacy at the federal level, and an amazing quarterly magazine, among other things.

For the past six years, our Quarterly Report has been led and edited by Dawn Greaves. Dawn has done yeoman’s work through a change in our association management, the COVID-19 pandemic, and a re-branding of our name and image. Despite all of that, the Quarterly Report has grown, evolved, and flourished under her leadership.

The Quarterly Report has grown in size from twelve pages to twenty-eight pages, included much more clinically focused content, and transitioned to a nearly all-electronic publication. Dawn has driven all of this during her term as Editor. I want to personally thank Dawn for her service to APTA Home Health and its members. Without people like Dawn, our Academy would not deliver the value that you, our members, expect and deserve.

Of course, our Quarterly Report will remain in talented hands. The remainder of our Publications Committee continues to generate content and “carry the water”. They will be ably led by our new Editor, Kristin McCormack. Please join me in welcoming Kristin, and please continue to support our Quarterly Report simply by reading it when it drops into your e-mail. If you want a printed copy, please contact our office, and we will be happy to help you opt-in to this.

If you want to join ANY of our committees (Practice, Publications, Public Relations, Government Affairs, Research, Finance, or Membership), please contact our office and we will share your information with the appropriate committee chair. All members—PTs, PTAs, and students—are welcome to serve on committees.

Sincerely, 

Phil Goldsmith
President
APTA Home Health 

CMS' 2030 Value-Based Care Goal at 'Inflection Point'

Modern Healthcare | By Michael McAuliff
 
The Biden administration's goal to move all Medicare beneficiaries into accountable care arrangements by 2030 may be just within reach, but is at a turning point.
 
The most immediate question that could determine the initiative's future is whether Congress extends a bonus program meant to help providers transition away from fee-for-service reimbursement and toward value-based payment before it expires this winter.
 
But longer-term issues have risen to the fore, such as how success is measured and rewarded, and both Congress and the Centers for Medicare and Medicaid Services will have to make adjustments to reach the final goal within five years, industry sources and analysts contended.
 
"We are at an inflection point of having to rethink this approach of how we set benchmarks and define what level of savings can be achieved in a model," said Aisha Pittman, senior vice president of government affairs at the National Association of Accountable Care Organizations.
 
TRACKING LAYOFFS & CLOSURES
 
CMS set its goal not long after President Joe Biden took office in 2021, when about 10.7 million people got their care from Medicare Shared Savings Program ACOs, according to the Medicare Payment Advisory Commission.
 
The shared savings population sat at 10.8 million when this year began. Overall, 24% of Medicare beneficiaries were in an accountable care arrangement, while 22% were in traditional fee-for-service, and the rest were in Medicare Advantage. All told, 13.7 million Medicare enrollees were in some sort of accountable care arrangement, CMS announced in January.
 
Over the same span, the number of ACOs has stayed about the same, rising from 477 in 2021 to 482 this year.
 
"We're kind of in an awkward adolescence, in many ways, with value-based payment," said Rob Saunders, senior research director at the Duke University Margolis Institute for Health Policy.
 
Whether or not the push value-based care from the Center for Medicare and Medicaid Innovation, which runs the campaign, has been successful depends who you ask and what metrics they use.
 
For instance, dissatisfaction with CMMI has grown on Capitol Hill, where skeptical lawmakers regularly point to an analysis the Congressional Budget Office published in September 2023, which found the innovation center had tested 49 models yet only approved five expansions, all while raising spending by $5.4 billion instead of saving money.
 
Still, non-political observers say there are good reasons for what looks at first glance like a high rate of spending and failure: The innovation center is testing out many new ideas, just as Congress and President Barack Obama tasked it do under the Affordable Care Act of 2010…

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‘A Deteriorating Industry’: What Home Health Provider Margins Actually Look Like

Home Health Care News | By Andrew Donlan
 
The Medicare Payment Advisory Commission (MedPAC) paints a rosy portrait of home health margins. But an analysis of cost reporting data – that considers both traditional Medicare and Medicare Advantage (MA) payments – shows that providers are generally not sitting atop a hill of money. Instead, they are struggling to stay above water. 
 
Kalon Mitchell sold his company to the post-acute technology organization WellSky in 2018. He then worked for WellSky for five more years, learning the ins and outs of the home health industry in the meantime. 
 
After leaving WellSky, and with some more time on his hands, Mitchell decided to start “Project Sword”, which leverages cost reporting data to analyze the financial position of home health providers at large. 
 
The data shows not an industry enjoying close to 20% margins, but instead one that is in a deeply precarious position moving forward. 
 
The Centers for Medicare & Medicaid Services (CMS) has proposed cuts to home health payments three years in a row. Though its last two final payment rules have not been as harsh as its proposals, they have still come with permanent cuts to payments. 
 
Providers have multiple gripes with these cuts. The first is over the payment methodology that CMS applies, which most providers and advocates strongly disagree with. The second is the rising costs that home health agencies have recently faced. While CMS is cutting home health payment in traditional Medicare, the cost of providing services has skyrocketed – namely due to the cost of labor. 
 
But the final gripe is the one that has turned into a “generational battle” for providers, and that is MA penetration and payment. 
 
Over 50% of Medicare beneficiaries are now under an MA plan, and those plans generally pay far less for home health care than traditional Medicare. 
 
Providers have regularly told Home Health Care News that MA payment for home health services doesn’t cover the cost of delivering care. But providers tend to be mission driven, and also have referral relationships to uphold. Therefore, they continue to take on MA patients, which sinks their overall margins. 
 
Essentially, traditional Medicare subsidizes MA plans in home health care. It’s true that if providers only took traditional Medicare, they would likely enjoy healthy margins. On the other end, though, if they only took MA, they’d likely have inoperable businesses. 
While providers have shared these MA payment horror stories anecdotally, it’s been hard to get a good overall picture of what the average home health provider’s margin looks like of late – as both MA penetration and traditional Medicare rate cuts continue unabated…

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Report: Home Health Referrals Up, Acceptance Down

NAHC Report

Home health agencies are generating more referrals from their acute care partners, but acceptance of those referred patients is not keeping pace, according to the new “Evolution of Care” report from WellSky, that examined data from about 130,000 health care providers, including home health agencies, hospitals, and other sources.

Home health referrals are up about six percent in the last year, according to the report, which about doubles the growth in referrals to skilled nursing facilities. Last year, home health saw a 22 percent average increase in the total number of referral gains in 2023. “Demand for post-acute care shows no signs of slowing,” wrote the report’s authors. “The growth in referral volume likely reflects the increasing demand for post-acute care by older, more medically complex patients.”

Interestingly, referral volume is higher now than it was before the COVID-19 pandemic, suggesting the pandemic has had an enduring impact on the demand for post-acute care in the United States.

However, the share of referred patients accepted to post-acute care is declining, with less than 35 percent of refferals accepted by home health agencies of of October 2023. That’s a drop from before the pandemic, when almost half of all patients referred were accepted, according to the report.

“Acute providers are still struggling to secure post-acute care in a timely manner for their patients,” reads the report. “While [SNF] acceptance rates have improved since our last report, they remain lower than pre-pandemic levels. In contrast, home health acceptance rates remain consistently and significantly lower than pre-pandemic acceptance rates, despite home health receiving more referrals per patient.