MedPAC Issues March 2022 Report to Congress: Medicare Payment Policy

From NHPCO

Summary at a Glance

As previously reported, on March 15, 2022 the Medicare Payment Advisory Commission (MedPAC) released its March 2022 Report to the Congress: Medicare Payment Policy. The hospice chapter provides MedPAC’s analysis of the current state of hospice – beneficiary access to care, quality of care, and Medicare spending and margins. MedPAC found that “the indicators of payment adequacy for hospices are positive” and therefore concluded the chapter with the following recommendations for Congress:

“The Congress should:

• For fiscal year 2023, the Congress should eliminate the update to the 2022 Medicare base payment rates for hospice and wage adjust and reduce the hospice aggregate cap by 20 percent.

• The Secretary should require that hospices report telehealth services on Medicare claims.”

MedPAC noted that the rationale for the Commission’s March 2021 cap recommendation is due to aggregate payments being “more than sufficient to cover providers’ costs” and concluded that aggregate payments “should be reduced by wage adjusting and reducing the hospice aggregate cap, an approach that focuses payment reductions on providers with the longest stays and high margins.” NHPCO continues to highlight the unintended consequences of the MedPAC recommendations on beneficiary access and quality of care delivered by hospice providers. NHPCO has been actively engaged with MedPAC staff and Commissioners on these issues and submitted official comments multiple times regarding the potential impact of any cut to aggregate cap. We have specifically expressed concern about the impact on access, quality, and cost containment in rural and underserved areas and have requested that MedPAC revisit the original intent of such a cap and relevance today.

Note: Providers should remember that MedPAC is an advisory body that makes recommendations to Congress. Even with a unanimous vote in favor of any recommendation, including modifications to the hospice aggregate cap, Congress must adopt the necessary legislative changes to put these recommendations into effect

Omnibus Provides Diverse Funding Options For Health Care Workforce

Inside Health Policy / By Bridget Early

As a worsening health care workforce crisis continues to plague providers across the country, federal legislators envision a financial fix including $1.3 billion for the health care workforce in the fiscal 2022 omnibus spending package, which passed the House and Senate this week and would address staffing shortages and bolster retention efforts across a multitude of struggling sectors.

Legislators and stakeholders have discussed a number of ways to slow the skyrocketing rates of resignations and retirements that have been exacerbated by the COVID-19 pandemic. Student and educator loan forgiveness, increased graduate medical education slots, fast-tracked visa processes for foreign national providers, and broad additional funding for facilities have all been considered.

The omnibus funding encompasses all of these options, according to an explanatory statement that accompanies the legislation, with a special focus on groups experiencing the most acute worker shortages, including nurses, maternal care specialists, behavioral health specialists and rural providers.

Loan forgiveness and scholarships. The omnibus package includes $3.5 million in scholarships for disadvantaged students to educate midwives. The explanatory statement says this is meant to address the national shortage of maternity care providers and the lack of diversity in the maternity care workforce.

For nurses, the package includes $280.5 million for staff education and retention efforts, loan forgiveness and scholarships, which experts have recently lauded as a prime method of expanding the nursing pipeline. A complementary fund for loan forgiveness for nurse faculty would receive $28.5 million, the explanatory statement says.

The omnibus package also includes several separate funding pots for the education of health care providers, the explanatory statement says, such as $55 million for medical student education; $20 million for graduate psychology education; $24 million for substance use disorder treatment and recovery loan repayment programs; and $5 million for pediatric subspecialty loan repayments...

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From Alabama to Utah, Efforts to Vaccinate Medicaid Enrollees Against Covid Run Into Obstacles

KHN / By Phil Galewitz

Medicaid enrollees continue to get vaccinated against covid at far lower rates than the general population despite vigorous outreach efforts by government officials and private organizations to get low-income people inoculated, according to data from several states.

That leaves many Medicaid enrollees — who tend to be sicker than those with private insurance — at higher risk for severe illness, hospitalization, or death from the virus.

Nationally, more than 215 million Americans — including 75% of adults and 57% of children ages 12 to 17 — are fully vaccinated, according to the Centers for Disease Control and Prevention. Among children 5 to 11 years old, who have only been eligible for a shot since early November, about 25% have been fully vaccinated. A vaccine has not yet been authorized for children younger than 5.

Read more @ KHN

Value-Based Care Through Postacute Home Health Under CMS PACT Regulations

The American Journal of Managed Care, February 2022, Volume 28, Issue 2 (Racsa et al.)

ABSTRACT

Objectives: To assess in a Medicare Advantage population (1) whether discharge to home health, compared with discharge to home, following an inpatient stay subject to CMS postacute care transfer (PACT) regulations, is associated with better outcomes or lower expenditures and (2) whether the impact differs among subpopulations.

Study Design: Claims-based retrospective cohort study.

Methods: Instrumental variable (IV) analysis, with prior hospital-level probability of discharge to home health as the IV, to control for unobservable as well as observable confounders.

Results: Compared with 15,071 patients discharged to home, 4160 patients discharged to and receiving timely home health services were 60% less likely to be readmitted within 30 days and 37% less likely at 90 days. Total expenditures from time of admission to 90 days post discharge were 11% lower in the home health group. The association of discharge to home health with reduced readmission and reduced costs varied by subpopulations defined by surgical vs medical diagnosis-related group and receipt of intensive care management following discharge.

Conclusions: The PACT policy may be promoting greater value by reducing readmissions while lowering total expenditures for patients who do not require intensive postacute care. Findings were in contrast to those of previous studies, in which discharge to home health has been associated with higher rates of readmission. Earlier studies did not control for unmeasurable confounders, involved narrowly defined populations, and used older data.

Read Study at https://doi.org/10.37765/ajmc.2022.88827