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With MA Cuts Coming, Home Care Supplemental Benefits Hang In The Balance
Home Health Care News | By Andrew Donlan
Home care providers have complained about Medicare Advantage (MA) becoming a more mainstream payer source.
Still, many have begun to work with MA plans for the first time over the past few years. But now, there’s concern that the government’s crackdown on MA could restrict opportunities even further, particularly when it comes to supplemental benefits.
“There’s no question that the recently proposed risk-adjustment policy would reduce payments enough that plans would certainly reduce supplemental benefit offerings,” ATI Advisory founder and CEO Anne Tumlinson told HHCN in an email.
Specifically, the U.S. Centers for Medicare & Medicaid Services (CMS) is attempting to cut plans’ payment rate by 2.27%. CMS is also hoping to regain billions of dollars in overpayments from major insurers in the near-term future.
That, some believe, could mean that plans are “less generous” with the supplemental benefits they offer. Health Affairs covered the issue in an analysis published Wednesday.
“Concerns that … plans are overpaid have motivated calls to reduce MA benchmarks – the dollar amounts set by [CMS] against which MA plans bid to set premiums and fund extra benefits,” the Health Affairs analysis states. “However, cutting benchmarks may lead to higher MA enrollee premiums and decreased plan generosity.”
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Medicare Advantage Value-Based Insurance Design (VBID) Model to be Extended
The Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model will be extended for calendar years 2025 through 2030 and will introduce changes intended to more fully address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness.
The CMS Innovation Center looks forward to sharing more information on model updates when available. For more information on the current model design, see our overview CY24 RFA fact sheet. You can also contact the model team at [email protected]. |
LeadingAge Poll Shows Stagnant Workforce Issues, Foreign Workers as Potential Solution
Health Leaders Media | By Jasmyne Ray
A small percentage of the aging services providers the nonprofit association represents has found success hiring foreign workers through work-based visas.
KEY TAKEAWAYS
- Poll results show that there hasn't been a positive change regarding workforce struggles for over half of aging services providers.
- With some staff leaving their positions for better pay elsewhere, nursing homes and home health agencies are having to limit the number of patients they care for.
- Some organization's have seen success in recruiting foreign workers, but policymakers will need to take action to make the process easier.
In a recent poll, 64% of aging services providers stated their workforce situation hasn't improved since June 2022.
The poll, conducted by LeadingAge, a nonprofit association representing aging services providers across the country, shows that providers continue to struggle with hiring and retention, worsening financial burdens, and frustration with policymakers’ lack of action.
"The hours are insane for the pay people get. It is not uncommon to have staff routinely working 60+ [hours] per week because they do not want to let their residents go without," a LeadingAge member stated. "I have been doing this for 32+ years and this is the most dire time I have ever seen."
LeadingAge last surveyed its members in 2022 on similar issues to gain insight on their struggles.
Staffing struggles
Results of the poll showed that the three most difficult positions to hire for are registered nurses (86%), licensed practical nurses (85%), and certified nursing assistants (85%). Many have found that current staff are leaving their positions for better-paying roles (78%) and better hours (53%).
Another 73% are leaving due to burnout.
Member comments included with poll results note that some providers turn to agencies for staffing, which can be costly. As a result, nursing homes and home health agencies are limiting the number of patients they serve to ensure they can provide quality care with the staff they have.
Getting creative
70% of respondents said they've implemented different strategies to help with recruitment efforts, including offering sign-on bonuses (69%), flexible scheduling (61%), and emphasizing career advancement opportunities (56%).
92% of providers have offered increased hourly wages to employees in hopes of retaining them.
"We have closed units or delayed filling apartments … due to insufficient staff to provide quality care in SNF and memory care assisted living;" one provider commented. "Staffing continues to get worse, so [we] anticipate additional measures may need to be taken if it doesn't turn around."
Other options
Some organizations have found success in recruiting foreign workers to work in the United States through work-based visas (12%) or on refugee status (5%). The interest in foreign recruitment overall is high, according to almost 200 member comments from the poll. To make this process easier, they will need help from policymakers.
"We are in the process of starting a foreign workers program, but our approval for prevailing wages has been pending for 6+ months," one provider said. "There seems to be no urgency among the government agencies involved in this process."
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New Home Health Advocacy Video to Watch and Share!
As a home health advocate, you know how vital the care our community provides is for seniors in need. Now, a new video is helping to educate lawmakers about the incredible value that home health offers our most vulnerable seniors, their families, and our healthcare system.
The video features Ms. Alice, a Medicare home health patient who has returned home after experiencing a stroke and an extended stay in a skilled nursing facility. The video features testimonials from Ms. Alice, her daughter, and her home health care team.
Click below to watch the video:
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New OASIS-E Resources Available: GG0170C, GG0170L, and GG0170P Video Tutorials
The Centers for Medicare & Medicaid Services is releasing short video tutorials to providers in the LTCH setting. These 5-minute videos are designed to provide targeted guidance using simulated patient scenarios to assist providers in coding GG0170C. Lying to Sitting on Side of Bed, GG0170L. Walking 10 Feet on Uneven Surfaces, and GG0170P. Picking Up Object. To access the videos, click on the links below:
If you have questions about accessing the resources or feedback regarding the trainings, please email PAC Training. Content-related questions should be submitted to the LTCH QRP Help Desk. |
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