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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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Summary of Hospice Updates in Recent CMS Open Door Forum
NAHC
The Centers for Medicare & Medicaid Services (CMS) held its most recent Home Health, Hospice and DME Open Door Forum on Wednesday, January 10, 2024. Following are the hospice items that were discussed.
The next Care Compare refresh will be in February. The Provider Preview reports for this refresh were made available to hospices in their CASPER folders in November 2023.
The next CAHPS Hospice Survey submission deadline is February 14, 2024. Survey data from Q3 2023 (July – September) is included in this submission. Hospices are encouraged to check the Data Warehouse to ensure their vendor has submitted the data on their behalf.
In the Q&A portion of the Forum, CMS was asked if there will be an update to the hospice interpretive guidelines (CMS State Operations Manual (SOM), Appendix M) to reflect the option to include Marriage and Family Therapist (MFT)/Mental Health Counselor (MHC) in the hospice interdisciplinary group (IDG). CMS responded that it Q&As specific to this topic are currently going through the clearance process and are expected to be posted soon, perhaps the week of January 15. Once the Q&As have been finalized and posted, CMS will be working on the interpretive guidelines, which will take some time, and posting these updates via a QSO memo. Stay tuned to NAHC Report for more information as it becomes available.
Listeners were also interested in any HOPE (Hospice Outcome & Patient Evaluation) updates. CMS indicated that the next update will be in the hospice proposed rule scheduled to be released this spring. |
Base Wage Claim Hold Notification
In accordance with IM 24-002, provider claim holds will begin in earnest [Friday 01/12/2024] for those who have not yet responded to the 2023 base wage attestation. Additionally, the Office of Community Living ha2 also published providers not restricted by safe harbor (those who serve under 30 members) who are non-compliant with base wage requirements on this website. Please note, there are a lot of providers who fall into that under the safe harbor rule.
If you are unable to bill any Medicaid lines, it is likely due to this action. You may still provide the necessary forms as required in regulation by visiting the aforementioned website and following the guidelines for wage attestation. |
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Industry Survey: Staffing, Alternative Payment Models Top-of-Mind for Home Care Providers
McKnight’s Home Care | By Liza Berger
Home care providers in the year ahead are most concerned about staffing and payment issues related to alternative payment models. That is according to a 2024 industry trends survey released Monday by technology firm Axxess, in partnership with the Council of State Home Care and Hospice Association and the Forum of State Associations.
“Hospice and home healthcare reimbursement is shifting toward a focus on both value and quality so embracing technology is the fastest way to elevate operations in a way that improves efficiency, optimizes outcomes and attracts and retains staff,” the survey said.
In the December 2023 survey, which canvassed “thousands of home-based care providers from agencies of all sizes,” 62% of respondents said staffing most concerns them in the year ahead, while 51% said changing payment dynamics related to alternative payment models represents their biggest challenge. Other worrisome issues are regulatory changes, audit scrutiny and oversight (37%); and employee engagement, nearly 35% of respondents said.
Feeling Unprepared
Still, providers remain largely unprepared for possible reimbursement changes ahead. In response to the question, “Are you prepared for major regulatory changes, like shifts in reimbursement models or new compliance requirements?,” 35% of respondents said they are unsure while 34% said they are somewhat prepared. Around 17% said they are fully or completely prepared.
Providers are looking largely to improved operational processes to improve their bottom lines this year, the survey found. Around 63% of respondents said improved operational process has the biggest opportunity to improve the bottom line in 2024. That was followed by growing market share (approximately 42%) and strategic partnership (30.4%).
The Big Bet: Employee Engagement Technology
In the area of technology, slightly more than 47% of respondents said employee engagement technology will yield the greatest return on investment this year. That was followed by staff training technology (45.4%) and patient engagement technology (35.7%).
Axxess’ professional services team and leaders from both partner organizations offered several best practices to consider. Among these: Attract top talent, develop a strategic plan focused on enhancing employee well-being and assess how your technology ecosystem drives organizational health. |
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):
- Hip replacement
- Knee replacement
- Spinal fusion
- Cataract surgery
- Colonoscopy
- Hernia repair – groin (open)
- Hernia repair (minimally invasive)
- Mastectomy
- Coronary artery bypass graft (CABG)
- Pacemaker insertion or repair
- Coronary angioplasty and stenting
- 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. |
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