Ask Congress to Continue to Again Extend Full Sequester Relief

Partnership for Quality Home Healthcare Update

In response to the ongoing challenges related to the COVID-19 public health emergency, Congress took action last year to again extend the temporary suspension of the 2% sequester to Medicare providers.  However, this 2% relief is set to expire at the end of March.

As the pandemic endures and more transmissible variants of COVID-19 emerge, sequestration relief is still needed. Home health providers are continuing to experience significant challenges, particularly related to workforce and staffing and need additional time to effectively manage the far-reaching impacts of new surges of COVID.

Congress must immediately take action to again extend the full sequester relief to ensure stability to the home health provider community and all providers struggling to deliver quality services to the Medicare population as the pandemic continues. The March omnibus spending bill, which must be passed by March 11, may be the last opportunity to extend the sequester suspension before relief expires.

Please send emails to your lawmakers in Congress today asking them to extend the Medicare sequester suspension in the March omnibus package!

Health Systems Advocate for Continued Hospital-at-Home Care Delivery

Health Tech Magazine
 
After two years of shifting care models to meet patients in their home, some of the top healthcare organizations are advocating to continue reimbursement for hospital-level home care. In February, more than 15 U.S. healthcare providers formed the Advanced Care at Home Coalition to push the Centers for Medicare and Medicaid Services (CMS) for a care model that focuses on at-home care.
 
The coalition is compiling best practices, and points out that costs, comfort and improved care make their case for more robust home-based care. For example, a study by the Journal of General Internal Medicine found that the cost of care for at-home patients is nearly half that of hospitalized patients.
 
“Advanced-care-at-home programs are based on a growing body of evidence that show patients are more satisfied with their care and family stress is reduced,” says Dr. Stephen Parodi, associate executive director, The Permanente Medical Group at coalition member Kaiser Permanente. “Patient functional mobility and activity tends to be higher, and quality outcomes are the same or better than being in a hospital.”
 
The Need to Continue Care at Home
 
Since 2020, hospital beds have been filled with patients battling COVID-19, and providers have found it safer to provide many patients with home-based care plans for a range of treatments, including infusions, skilled nursing, medications, laboratory and imaging services, behavioral health and rehabilitation services.
 
Dr. Pippa Shulman, chief medical officer for coalition member Medically Home, says at least 20 percent of hospitalized patients could safely be treated and monitored from their homes. Shulman adds that benefits vary based on the patient and the provider, but overall home treatment allows hospitals to safely care for more people.
 
“One vantage point is that hospital-at-home programs enable health systems to add capacity to their systems and care for more patients without incurring the sometimes-prohibitive costs associated with adding bed capacity inside their facilities,” Shulman says. 

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Why Political Roadblocks Threaten Home Health Care’s Biggest Policy Objectives in 2022

Home Health Care News | By Andrew Donla
 
Policy concerns in home-based care are considered timely and critical for those in the industry. The issue is, unfortunately, they aren’t always viewed in that light by outsiders and lawmakers in Washington, D.C.
 
Among those concerns are the extension of the Acute Hospital Care at Home waiver, adequate reimbursement for telehealth and the Choose Home Care Act.
 
“There is a level of gridlock and partisanship in Washington, D.C., that’s created a limited number of opportunities, which is disappointing,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), said during a Home Care 100 panel discussion earlier this month. “But I think we are extraordinarily well positioned. And maybe in March, there will be opportunities for further legislation.”
 
Choose Home is still awaiting a score from the Congressional Budget Office (CBO), which similarly, has a lot on its plate. If Choose Home’s passage were put to Vegas odds, Dombi said that advocates are certainly “not playing with house money.” He did, though, give it an “even” chance of passing this year – meaning about 50%.
 
As for hospital-at-home legislation that would extend the Acute Hospital Care at Home waiver – which is tied to the public health emergency (PHE) – Dombi and others are more bullish.
 
A handful of senators have already drafted legislation to extend it, according to Alison Armstrong, the executive director of Moving Health Home. . .

Telehealth reimbursement
 
Home health care providers have been granted more flexibilities relating to telehealth during the PHE, but are still not fully paid for their remote visits.
 
It has been advocated for on a non-stop basis over the last two years, and yet there hasn’t been much tangible progress. And there’s a reason for that.
 
“From a Medicare home health perspective, you’ve got a roadblock,” Dombi said. “The statute itself prohibits payment for telehealth services within the payment model.”
 
In order to turn the corner on telehealth reimbursement for home health, the only feasible route advocates can take is through Congress. From there, a demo program would have to be created by the Center for Medicare & Medicaid Innovation (CMMI).
 
Another potential roadblock, however, is that telehealth has been abused during the pandemic. Not necessarily by home health providers – it would be hard to abuse it without corresponding pay – but instead by other health care providers across the continuum. . .
  
HHVBP concerns
 
Home health providers have the year ahead to gear up for the 2023 expansion of the Home Health Value-Based Purchasing (HHVBP) Model.
 
For the most part, the reaction to that news has been positive.
 
There are dissenters, though. Specifically, there are providers that believe the line being drawn between “winners” and “losers” in HHVBP is too binary. For instance, a small difference in level of performance could separate the 45th-percentile and 55th-percentile agencies.
 
The president and CEO of Visiting Nurse Association Health Group, Dr. Steve Landers, is also in favor of the expansion of HHVBP, but does think some questions are warranted for value-based care programs in general.
 
“I think having the payment model be reflective of outcomes is a good evolution,” Landers also said on the panel. “It intends to incentivize excellence. And that’s we want to be doing as teams and also as an industry.”
 
The nine-state demonstration program of HHVBP saved $600 million, Landers mentioned. That is a testament to the industry’s work, but also makes one wonder where the savings are going, he said. . .

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CMS Submits OASIS-E to OMB

By the National Association for Home Care (NAHC)

The Office of Management & Budget (OMB) has issued the information collection packet for the Outcome and Assessment Information Set (OASIS)-E, which includes three attachments and the Supporting Statement document outlining the burden estimate for both home health agencies (HHAs)  and the federal government.

The OASIS-E assessment tool is effective January 1, 2023.

Attachment A is an  OASIS-E change table that compares the changes made to OASIS-E from the OASIS-D . Attachment B includes all of the OASIS items, and Attachment C is an itemized list of the OASIS-E data elements.

As usual, in the supporting statement, the Centers for Medicare & Medicaid Services (CMS) underestimates the burden for HHAs to complete the OASIS-E data set. CMS projects that assessment items in the data set will take a range of 0.15-0.3 (9-18 seconds respectively) minutes of clinician time to complete.

• Estimated time spent per each OASIS-E Start of Care (SOC) Assessment/Patient = 57.3 clinician minutes for 203 data elements
• Resumption of Care (ROC) Assessment/Patient = 48 minutes for 172 data elements
• Estimated time spent per each OASIS-E Follow-Up (FU) Assessment/Patient = 13.2 minutes for 4 data elements
• Estimated time spent per each OASIS-E Discharge (DC) Assessment/Patient = 40.2 minutes for 146 data elements

This assumption provides that even the most complex assessment items ( e.g. the GG items and the new cognition items) will require, at most,18 seconds to complete.

CMS also reveals changes it plans to propose for Patient Driven Groupings Model (PDGM)  in the CY 2023 home health payment update rule.  Pending the adoption of these changes, CMS will add the following items to the FU assessment.

• Shower/bathe self
• Upper body dressing
• Lower body dressing
• Putting on/taking off footwear
• Car transfer
• Walk 150 feet
• 12 steps
• Wheel 150