Elimination Of Non-Competes Would Have ‘Major’ Effect On Home-Based Care World

Home Health Care News | By Andrew Donlan
 
In early January, the Federal Trade Commission (FTC) proposed a ban on non-compete agreements nationwide.
 
The rule is likely to be finalized. When and if it does, it is also likely to have a massive effect on the home health and home care industries.
 
Such a move would not just hurt companies by allowing leaders to jump ship, but it would also muddy the waters on a slew of contractual agreements between caregivers and clients.
 
“I definitely think it’s major. It’s extraordinarily significant,” Angelo Spinola, the chair of home care, home health and hospice at the law firm Polsinelli, told Home Health Care News. “If you can’t stop a key executive from leaving and competing against you, that will have a significant impact on the industry.”
 
The proposed rule can be traced back to the Biden administration’s Aug. 2021 request to the FTC to take a longer look at restricting or banning non-compete agreements. Broadly, the idea was that non-competes restricted workers’ mobility and ability to make a livable wage.
 
It seemed at the time that President Biden was referring to low-wage workers specifically. And while this would have an effect on, for instance, the caregiver-provider relationship, it would also be a major shake-up in what home-based care leadership could do when looking for new opportunities.
 
For instance, Spinola offered up the example of a home health administrator. They could be trained up by a home health organization, promoted and given access to all the patient data and pricing of an organization.
 
“Now that individual says, ‘You know what, I’ve got all the relationships. And I’ve been collecting a salary from the owner. But now I’m just going to go across the street, and I’ll open my own agency. I’ll wait for those clinicians to call me and start working with me. And the relationships I’ve developed with the facilities and those referral relationships, I’ll just bring those over,” he said.
 
Home-based care leadership has already been in disarray, to a certain extent. Big-time executives have either left their posts or been forced out in the wake of COVID-19 and other unfavorable market conditions.
 
If the FTC ruling becomes final, that could become even more so the case.
 
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US Health Officials Propose Annual COVID-19 Vaccination for Most Americans

Associated Press
 
WASHINGTON — U.S. health officials want to make COVID-19 vaccinations more like the annual flu shot.

The Food and Drug Administration on Monday proposed a simplified approach for future vaccination efforts, allowing most adults and children to get a once-a-year shot to protect against the mutating virus.
 
This means Americans would no longer have to keep track of how many shots they’ve received or how many months it’s been since their last booster.
 
The proposal comes as boosters have become a hard sell. While more than 80% of the U.S. population has had at least one vaccine dose, only 16% of those eligible have received the latest boosters authorized in August.
 
The FDA will ask its panel of outside vaccine experts to weigh in at a meeting Thursday. The agency is expected to take their advice into consideration while deciding future vaccine requirements for manufacturers.
 
In documents posted online, FDA scientists say many Americans now have “sufficient preexisting immunity” against the coronavirus because of vaccination, infection or a combination of the two. That baseline of protection should be enough to move to an annual booster against the latest strains in circulation and make COVID-19 vaccinations more like the yearly flu shot, according to the agency.
 
For adults with weakened immune systems and very small children, a two-dose combination may be needed for protection. FDA scientists and vaccine companies would study vaccination, infection rates and other data to decide who should receive a single shot versus a two-dose series.
 
FDA will also ask its panel to vote on whether all vaccines should target the same strains. That step would be needed to make the shots interchangeable, doing away with the current complicated system of primary vaccinations and boosters.
 
The initial shots from Pfizer and Moderna — called the primary series — target the strain of the virus that first emerged in 2020 and quickly swept across the world. The updated boosters launched last fall were also tweaked to target omicron relatives that had been dominant.
 
Under FDA's proposal, the agency, independent experts and manufacturers would decide annually on which strains to target by the early summer, allowing several months to produce and launch updated shots before the fall. That’s roughly the same approach long used to select the strains for the annual flu shot.
 
Ultimately, FDA officials say moving to an annual schedule would make it easier to promote future vaccination campaigns, which could ultimately boost vaccination rates nationwide.

The original two-dose COVID shots have offered strong protection against severe disease and death no matter the variant, but protection against mild infection wanes. Experts continue to debate whether the latest round of boosters significantly enhanced protection, particularly for younger, healthy Americans.

What's Ahead for Health IT Policy and Legislation in 2023

Healthcare IT News | By Andrea Fox
 
With Congress providing telehealth waivers as part of its omnibus spending bill at the close of 2022, delaying the "telehealth cliff" for two years, HIMSS says it's now ready to make the case for permanent reimbursement of virtual care.
 
Also on its policy agenda for the year ahead: advocating for data standardization, offering input for interoperability rulemaking and engaging with agencies and states to increase telehealth access. We spoke with the HIMSS government relations team for their thoughts on those priorities and more in 2023 and beyond.
 
Making telehealth's case for cost control
 
Telehealth has proven to reduce burdens on healthcare providers and improve access and has been a priority for HIMSS for many years, but the Congressional Budget Office has long complained that all of the data has been for non-Medicare patients, explained Tom Leary, senior vice president and head of government relations at HIMSS, parent company of Healthcare IT News.
 
Budget leaders have asked, "How do you really know what the impact on the Medicare population and the Medicare Trust Fund will be? We now have three years of data on the impact to the Medicare Trust Fund," he said.
 
While the pandemic-era telehealth waivers answered many questions at the federal level, the two-year extension to offer telehealth in high-deductible health plans with health savings accounts included in the final legislative package of 2022 has opened a new window to pursue making the changes permanent. 
 
HIMSS will "use the next two years to gather additional data to inform both Congress and CBO on either the cost of avoidance or the cost control aspects," said Leary.
 
In addition to making telehealth coverage permanent, simplifying access for patients is another goal for the mission-driven non-profit, whose goal is to reform the global health ecosystem through the power of information and technology

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Medicare Advantage Plans Brace for Final Controversial Risk Adjustment Rule by Feb. 1

Fierce Healthcare | By Robert King
 
Medicare Advantage (MA) plans are bracing for a final rule that could overhaul the risk adjustment process and may leave them on the hook for errors going back more than a decade. 
 
Plans have circled Feb. 1 as the date they expect the Centers for Medicare & Medicaid Services (CMS) to publish the final Risk Adjustment Data Validation (RADV) rule, which will govern how CMS audits for coding errors. Some plans have said they want to make sure a fee-for-service (FFS) adjuster to the audits is included, which would limit error rates made by MA plans to a similar rate in FFS. 
 
“What we will be looking for is hopefully the acknowledgment that a FFS adjuster is necessary to recognize the inherent error rate in all claims data sets within Medicare,” said Susan Diamond, chief financial officer for Humana, during a presentation at the J.P. Morgan Healthcare Conference earlier this month. 
 
Currently, CMS audits a subset of around 200 MA beneficiaries in a plan. It compares all of the diagnosis codes for those beneficiaries to their medical records to determine whether Medicare over- or underpaid for the diagnoses. CMS has tried since 2012 to instead extrapolate the results of the audit to the entire population of that plan.
 
In 2018, the agency released a proposed rule that got rid of the FFS adjuster. It also would apply the new rule’s methodology retroactively to plans dating back to 2011. 
 
CMS did not finalize the rule for several years in part due to a delay caused by the COVID-19 pandemic and has announced a new deadline of Feb. 1 to publish the final version. A copy of the final rule has been sent to the Office of Management and Budget, a key final step before publishing a regulation.
 
Insurers have said they are not opposed to additional oversight.
 
“Like all government programs, taxpayers and beneficiaries need to know that the Medicare Advantage program is well-managed,” said Tim Noel, CEO of UnitedHealthcare’ medicare and retirement business, during a briefing with reporters Tuesday.
 
But Noel cautioned that leaving out the adjuster could lead to “flawed” audit results and shift away from a well-established CMS position.
 
The problem with getting rid of the FFS adjuster is that it will hold plans to an impossible burden of no errors whatsoever in its claims, insurers argue.
  
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