Literature Review

Proposed hospice rule offers key quality improvement changes, experts offer McKnights Home Care, by Adam Healy; 4/4/24While the recently proposed 2025 hospice payment update included a payment adjustment that stakeholders have perceived as inadequate, it also introduced valuable new tools to address hospice quality and more, according to industry regulatory experts. One of the proposed rule’s most enticing features is the Hospice Outcomes and Patient Evaluation (HOPE) tool, which next year will replace the current Hospice Item Set (HIS) measurement system used by the Centers for Medicare & Medicaid Services to track hospice quality.

What home health providers need to know about the Medicare TPE Audit ProcessHome Health Care News, by Joyce Famakinwa;  4/2/24... TPE is a medical review program that began for the home health and hospice settings in December 2017. The goal of the program is to weed out improper payments by zeroing-in on providers with high claims denial rates or unusual billing practices. ... TPE has three pillars. Target refers to errors or mistakes that are identified through data in comparison to providers or peers. Probe is the examination of 20 to 40 claims. ... Education means helping providers reduce claim denials and appeals through one-on-one individualized education.

CMS finalizes 2025 Medicare Advantage rates Becker's Payer Issues, by Rylee Wilson; 4/1/24 CMS finalized a slight decrease in Medicare Advantage benchmark payments for 2025. The agency published its final rate notice for 2025 April 1. The final rule was largely similar to CMS' proposed payment rates issued in January. The agency will cut benchmark payments by 0.16% from 2024 to 2025. CMS estimated plans will see 3.7% higher revenue overall in 2025. MA risk score trend of 3.86% — the average increase in risk adjustment payments year over year — will offset risk model revisions that will lead to a 2.45% decline in revenue and a projected decline in star rating bonuses, according to the agency. 

CMS releases Hospice Payment rate update proposed rule [Industry voices] HomeCare News; 3/29/24... "While the proposed rule may appear to be fairly innocuous," said NAHC President William A. Dombi, in response to the rule announcement, "the hospice community should pay attention to the information request on high cost services as it may signal an emerging interest in payment model reform. What is missing is also notable, CMS has not proposed any program integrity measures to address continued concerns on the surge in hospice growth in certain parts of the country despite the warning signs presented." ...Editor's Note: Additional responses from "industry voices" include NACH Vice President Davis Baird; NAHC's Director of Home Health and Hospice Regulatory Affairs Katie Wehri; and CEO Leading Age Katie Smith Sloan.

[UPDATED] CMS 2025 proposed rule signals changes to quality measurement, omits program integrity actionsHospice News, by Jim Parker; 3/29/24In a proposed rule released [Thursday], the U.S. Centers for Medicare & Medicaid Services (CMS) proposed a 2.6% increase in hospice per diems for 2025. The agency also proposed two new quality measures and 2025 implementation of the Hospice Outcome and Patient Evaluation (HOPE) assessment tool to replace the Hospice Item Set.However, stakeholders in the hospice space contend that the increase is insufficient in light of continued inflation, interest rates, staffing shortages and wage hikes.

Home care providers’ creative benefit packages are paying off Home Health Care News, by Joyce Famakinwa; 3/26/24 ... Amid a persistently challenging labor market, home care companies are still constantly working on configuring the best possible employee benefits package for caregivers. Companies like Right at Home San Gabriel Valley, Devoted Guardians and Family Tree Private Care have emerged as standouts when it comes to crafting impressive benefits packages. ... 

[Pediatrics] North Dakota Health and Human Services announces new pilot program CBS KX News, by Nathaniel House; 3/26/24 North Dakota Health and Human Services (HHS) has announced that family members who provide extraordinary care to either a child or adult enrolled in an eligible North Dakota (ND) Medicaid 1915(c) waiver may receive payments from the state through the new Family Paid Caregiver pilot program. State funding for the pilot program was approved from the passage of Senate Bill 2276 during the 2023 legislative session. Eligible ND Medicaid 1915(c) waivers include the Autism Spectrum Disorder Birth Through 17 Waiver, Children with Medically Fragile Needs Home and Community-Based Services Waiver, Children’s Hospice Home and Community-Based Services Waiver and the Traditional Individual with Intellectual Disabilities and Developmental Disabilities Home and Community-Based Services Waiver. 

The Hospice Special Focus Program: What it is & why it is importantFORV/S, by Angela Huff; 3/25/24 The CMS Hospice Special Focus Program (SFP) aims to shed light on poorly performing hospices. CMS has publicly stated it is looking closely at the hospice industry due to increasing concerns regarding fraud, waste, and abuse. The Hospice Special Focus Program (SFP) is a new CMS program that identifies poor-performing hospices, takes action to inform the public, and engages those hospices to either improve their performance or terminate the hospice from the Medicare program. 

Insurer responses to Change outage fail to impress provider Modern Healthcare, by Nona Tepper and Lauren Berryman; 3/18/24Insurers have modified claims and payment operations amid the Change Healthcare network outage, but providers contend the moves are not enough to address their financial challenges.

CMS.gov: ACO Primary Care Flex ModelCMS.gov; 3/19/24The ACO Primary Care Flex Model (ACO PC Flex Model) is a voluntary model that will focus on primary care delivery in the Medicare Shared Savings Program (Shared Savings Program). It will test how prospective payments and increased funding for primary care in Accountable Care Organizations (ACOs) impact health outcomes, quality, and costs of care. The flexible payment design will empower participating ACOs and their primary care providers to use more innovative, team-based, person-centered and proactive approaches to care. The model, which starts January 1, 2025, aims to grow participation in ACOs and the Shared Savings Program and increase the number of people with Medicare in an accountable care relationship.

Private equity sets sights on home care, hospice, new report findsMcKnights Home Care, by Adam Healy; 3/14/24The home care segment increasingly has become an attractive target for private equity buyers, particularly personal care and hospice, according to the Private Equity Stakeholder Project, a nonprofit financial watchdog organization.

Home Care costs continue to increase, outpacing other long-term care settings Home Health Care News, by Andrew Donlan; 3/12/24 The pricing increases in home care have again outpaced other long-term care sectors, according to Genworth’s annual cost of care report. 

CMS hears you, hospice providersMcKnights Home Care, by Liza Berger; 3/8/24 Rarely does the Centers for Medicare & Medicaid Services succeed in shocking us. The large bureaucracy, which is not exactly known for its nimbleness, managed to do so this week when it abruptly cancelled the hospice component of the Value-Based Insurance Design Model. ... For those who wonder whether advocacy works, I’d chalk this up to a win for providers — and a clear example of advocacy in action.