US Senate Passes Stopgap Funding Bill to Avert Government Shutdown

Reuters | By David Morgan and Moira Warburton

The U.S. Senate took the risk of an impending partial government shutdown off the table on Wednesday as it passed a stopgap spending bill and sent it to President Joe Biden to sign into law before a weekend deadline.

The 87-11 vote marked the end of this year's third fiscal standoff in Congress that saw lawmakers bring Washington to the brink of defaulting on its more than $31 trillion in debt this spring and twice within days of a partial shutdown that would have interrupted pay for about 4 million federal workers.

The last near-miss with shutdown led to the Oct. 3 ouster of Republican U.S. House of Representatives Speaker Kevin McCarthy that left the chamber leaderless for three weeks.

But lawmakers have bought themselves just a little more than two months' breathing room. The Democratic-majority Senate and Republican-controlled House of Representatives' next deadline is Jan. 19, just days after the Iowa caucuses signal the start of the 2024 presidential campaign season.

"No drama, no delay, no government shutdown," Democratic Senate Majority Leader Chuck Schumer said prior to the vote.

McCarthy's successor, Speaker Mike Johnson, produced a stopgap funding bill that drew broad bipartisan support, a rarity in modern U.S. politics. Democrats said they were happy it stuck to spending levels that had been set in a May agreement with Biden and did not include poison-pill provisions on abortion and other hot-button social issues.

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CMS: Concurrent Hospice Care Improves Quality, Reduces Costs

Hospice News | By Jim Parker

Allowing patients to receive concurrent hospice and curative care reduces health care costs and improves quality.

The U.S. Centers for Medicare & Medicaid Services (CMS) has released its fifth and final report on the Medicare Care Choices Model (MCCM), which studied the effects of allowing individuals to receive hospice care without foregoing other treatments. 

The agency launched the MCCM in 2016. Initially slated to complete in 2020, CMS later extended it until December 2021. Throughout that period, the model hit every one of its targets — reducing costs, improving quality and family satisfaction, and keeping patients in their homes.

MCCM yielded positive results for every population subgroup that the demonstration examined, according to Keith Kranker, principal researcher for Mathematica and lead author of the CMS evaluation report.

“This model basically worked for everyone we’ve looked at. We really didn’t find subgroups that were not benefiting from the model,” Kranker told Hospice News. “We looked across these different diseases that made people eligible for the model, and for all the diseases finding these kinds of quality improvements and cost savings.”

The model’s 7,263 enrollees were Medicare fee-for-service beneficiaries with a six-month terminal prognosis due to cancer, congestive heart failure, chronic obstructive pulmonary disease, or HIV/AIDS.

These patients had also received a referral to one of the program’s participating hospices, met eligibility criteria for the demonstration and made the choice to enroll in MCCM.

Among patients who had died before the demonstration ended, MCCM reduced Medicare expenditures by $7,604 per enrollee, about a 13% reduction compared to a control group. Hospital admissions dropped 26% and emergency department visits fell by 12%.

Enrolled patients were also more likely to transition to the traditional Medicare Hospice Benefit. MCCM enrollees were 18% more likely to elect the benefit, and their average length of stay reached 42 days compared to 19 for a control group. These patients were also able to stay in their homes longer than non-participants, 183 days compared to 178.

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Home Health Providers Are Beginning To Tie Clinician Compensation To Value-Based Care Success

Home Health Care News | By Patrick Filbin

Home health providers are adjusting their operations to be better set themselves up for value-based care.
 
One thing they need to be sure of, though, is that those adjustments are making their way down to the front line.
 
“From an agency standpoint, providers are thinking as their reimbursement model changes, how are we being judged against competitors and how are patients choosing us?” Jonathan Dickinson, senior manager of financial consultation with SimiTree, told Home Health Care News. “They’re noticing that a lot of it is based on quality. Value-based purchasing is going to impact their revenue. Now they’re starting to ask themselves, ‘How do we then incentivize our clinicians who are doing the work in the field to emphasize that quality?”
 
Operationally, providers are shifting to models – both inside fee for service and outside of it – that require better quality of care, sometimes with fewer visits.
 
But that message needs to make its way down to the frontline workers.
 
“Providers are saying, ‘You’re giving us great quality as a clinician — even though you may do 10 visits or less a month — we’re still going to pay you the same incentive,’” Dickinson said. “Because the quality is going to drive our reimbursement. We typically are seeing this more as a quality incentive around a quarterly bonus.”
 
For example, a provider could pay a clinician $30 for every visit after their goal in a quantity-based incentive program.
 
Now, providers are paying clinicians $10 for every additional visit and the other $20 is tied to quality incentives that go back to a patient’s outcome.
 
“If you have a clinician who continually just says, ‘I’m just going to do visits and not care about quality,’ they’ll still get a small portion of incentive and revenue, but it won’t be as big as if they were to actually drop back the number of visits and do more quality work,” Dickinson said.
To execute this type of plan, communication is paramount.
 
The more an agency can articulate how the quality of care is tied to compensation, job security and the overall health of the business, the better off everyone will be.
 
“The more an agency can correlate the fact that winning on value protects their jobs and allows them to have compensation increases, the more they’ll be able to understand how this actually impacts them,” Frontpoint Health CEO Brent Korte told HHCN. “It deeply impacts them.”
Based in Dallas, Frontpoint is a home health and hospice company that specifically tailors its business model to take on Medicare Advantage (MA) patients. It’s also betting big on value-based arrangements.
 
At the end of the day, agencies can’t pay clinicians more when they don’t have the money to spend, Korte said.

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Home Health Providers Take Aim At CMS’ ‘Black Box’ Approach To Policymaking

Home Health Care News | By Joyce Famakinwa
 
Enough time has passed since the CY 2024 home health payment rule was finalized for providers to dive into its details, mull them over and respond. 
 
Though the rule is more favorable than the proposal the U.S. Centers for Medicare & Medicaid Services (CMS) first introduced in June, home health providers are not pleased with the final outcome. 
 
CMS didn’t address – and in some cases furthered – the concerns that many providers and industry stakeholders raised in the months and weeks leading up to the rule’s finalization. 
The rule comes with a 0.8%, or $140 million, aggregate increase to home health payments. In June, CMS proposed a 2.2% aggregate decrease for 2024, which would have been an aggregate decrease of $375 million. 
 
Plus, the rule finalized a -2.890% adjustment, which is half of the cut originally proposed back in June. 
 
“My initial reaction was that where we landed was an improvement over what was proposed,” Choice Health at Home CEO David Jackson told Home Health Care News. “I believe home health provides substantial economic upside for the Medicare program and for the beneficiaries. I continue to disagree with the methodology, as far as how it’s viewed as budget neutral.” 
 
When the rule was first released, some providers felt that relief. But that quickly wore off.
 
“I quickly came to the stark realization that CMS still was continuing with deep cuts — albeit they were kicking them down the road — despite the prevalence of respected third-party data highlighting that cuts have made problems with access to care a reality, not just an assumption,” David Totaro, chief government affairs officer at Bayada Home Health Care, told HHCN. 
 
Similar to Totaro and Jackson, other providers have voiced pushback to what they believe is CMS doubling down on its intention to implement the permanent adjustment cuts in the coming years. 

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