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‘The Stability of Home Health Care Is at Risk’: CMS Proposes 4.2% Decrease to Provider Payments in 2023

The U.S. Centers for Medicare & Medicaid Services (CMS) released its FY 2023 home health proposed payment rule late Friday.

It comes with a decrease to payment rates by 4.2%, or $810 million less compared to 2022 rates. Overall, the proposed rule looks to be one that will be disappointing to providers, and one they will refute heavily in the public comment period.

“This decrease reflects the effects of the proposed 2.9% home health payment update percentage ($560 million increase), an estimated 6.9% decrease that reflects the effects of the proposed prospective, permanent behavioral assumption adjustment of -7.69% ($1.33 billion decrease), and an estimated 0.2% decrease that reflects the effects of a proposed update to the fixed-dollar loss ratio used in determining outlier payments ($40 million decrease),” CMS wrote in its fact sheet.

The proposed rule validated concerns that providers have had since the hospice proposed rule and skilled-nursing-facility proposed rules came out earlier this year.

“We are very disappointed in the CMS proposed rule issued today,” William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), wrote in a comment shared with Home Health Care News. “The stability of home health care is at risk as a consequence of CMS proposing the application a fatally flawed methodology for assessing whether the PDGM payment model led to budget neutral spending in 2020. That has been made clear to CMS in the 2021 rulemaking and in multiple discussions since.”

They will likely argue that the proposal clearly does not take into account multiple factors currently hindering providers, including: raised labor costs, a severely high inflation rate and other ongoing heightened expenses related to COVID-19.

“With significantly rising costs for staff, transportation, and more, home health agencies across the country cannot withstand the impact of the proposed rate cut,” Dombi added. “Reliable analyses proves that PDGM underpaid home health agencies. We will be taking all steps to protect the home health benefit as this proposed rule advances and have fully prepared for Congressional action and more. “

On the hospice side, CMS recently proposed a 2.7% pay increase for 2023. Meanwhile, SNF operators saw a proposed downward adjustment to SNF payment rates by 4.6%.

The latter rate adjustment is partly to balance out the Patient-Driven Payment Model (PDPM), which is similar to the home health industry, in that adjustments are being made to the Patient-Driven Groupings Model (PDGM).

In that vein, CMS is proposing to apply a permanent prospective payment adjustment to the home health 30-day period payment rate. That would be to account for any increases or decreases in aggregate expenditures as a result of the “difference between assumed behavior changes and actual behavior changes,” due to the implementation of the PDGM and 30-day unit of payment.

The full fact sheet from CMS can be viewed here.

Edo Banach Stepping Down from NHPCO Leadership Role

After five years as the President & CEO of the National Hospice and Palliative Care Organization (NHPCO), Edo Banach has decided to step down from that role at the end of August.

Norman McRae, Chair of the NHPCO Board of Directors, said, “Edo came to NHPCO with the skills and expertise needed at a time of transition in the hospice and palliative care community and in the direction of NHPCO and our advocacy affiliate, the Hospice Action Network. For five years he poured his heart and soul into this organization. His leadership has helped us professionalize key elements of the benefits we provide to the community, most notably our best-in-class advocacy operations. During his tenure, NHPCO’s financial position has improved greatly, despite the tremendous challenges of the last two years. We are grateful to Edo for his leadership. His work has positioned NHPCO to continue to succeed into the future on behalf of our members and the entire hospice and palliative care community.”

Banach said, “My time with NHPCO has been one of the most fulfilling chapters of my career. Over the last five years, NHPCO has delivered on the promise to provide our members with the best possible resources, networking, education, and advocacy to advance their organizations, their careers, and the interests of the hospice and palliative community. I am proud of that work, I look forward to my next challenge, and I’ll remain a cheerleader for NHPCO.”

McRae added, “The NHPCO Board of Directors will use this summer to work with Edo and the NHPCO Leadership Team to plan for a smooth transition as we work with a national search firm to hire the organization’s next President & CEO. During the search, Ben Marcantonio, NHPCO’s COO will serve as interim President & CEO. Ben has more than 20 years of hospice and palliative care experience, including nine years of executive leadership with providers on both the east and west coasts.”

100 Million People in America Are Saddled With Health Care Debt

Kaiser Health News / By Noam N. Levey
 
Elizabeth Woodruff drained her retirement account and took on three jobs after she and her husband were sued for nearly $10,000 by the New York hospital where his infected leg was amputated.

Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills.

Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.

“I wanted to be a mom,” she said. “But we had to have the money.”

The three are among more than 100 million people in America ― including 41% of adults ― beset by a health care system that is systematically pushing patients into debt on a mass scale, an investigation by KHN and NPR shows.

The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.

To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on a nationwide poll conducted by KFF for this project. The poll was designed to capture not just bills patients couldn’t afford, but other borrowing used to pay for health care as well.

New analyses of credit bureau, hospital billing, and credit card data by the Urban Institute and other research partners also inform the project. And KHN and NPR reporters conducted hundreds of interviews with patients, physicians, health industry leaders, consumer advocates, and researchers.

The picture is bleak.

In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found.

A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to ever pay it off.

“Debt is no longer just a bug in our system. It is one of the main products,” said Dr. Rishi Manchanda, who has worked with low-income patients in California for more than a decade and served on the board of the nonprofit RIP Medical Debt. “We have a health care system almost perfectly designed to create debt.”

The burden is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy, the poll found…

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HHVBP Gives Providers More Support with Payers, But May Shrink Business Margins

Home Health Care News / By Andrew Donlan
 
Last Thursday, I moderated three panels at Home Health Care News’ VALUE event, sat in on another three and talked to dozens of attendees, both on the record and off.
 
There were plenty of highlights and insights that came from those conversations.
 
And while everyone seemed to not only have a good time, but also a productive one, my feeling is that the takeaways varied considerably from person to person.
 
Of course, some of that had to do with the diversified groups of providers involved. But mainly, it had to do with the overarching takeaway I had from our event: that most everyone in home-based care has a different definition of value-based care, and most everyone will take a different path to get there.
 
So while a shift toward value may be inevitable, there will be seemingly countless roads that lead there – not just one.
 
In this week’s exclusive, members-only HHCN+ Update, I explore what those different roads and definitions of value-based care may be, and also empty my notebook full of other learnings from the event.

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