Report: CMMI has Raised Federal Spending, Not Lowered it

Fierce Healthcare / By Noah Tong
 
The Center for Medicare and Medicaid Innovation (CMMI), once expected to save money and deliver healthcare at a lower cost, is increasing federal spending after all.
 
A report from the Congressional Budget Office (CBO) shows that the office increased direct spending by $5.4 billion between 2011 and 2020. CMMI spent $7.9 billion to operate models, but those models only reduced healthcare benefits spending by $2.6 billion.
 
The new figures reflect a stark contrast from CBO’s projections when the Affordable Care Act (and CMMI) was first enacted. CBO believed at the time that CMMI would reduce spending by $2.8 billion and lower spending on benefits by $10.3 billion, offsetting the $7.5 billion needed to operate CMMI’s models.
 
CBO now anticipates spending will increase an additional $1.3 billion from 2021 to 2030, though the office notes that the “budgetary effects of CMMI’s activities over the first decade and its updated projects are subject to considerable uncertainty.” For example, the report did not capture savings that were gained by accountable care organizations (ACOs) through the Medicare Shared Savings Program.
 
The agency believes that its incorrect projections can be attributed to several factors.
One, CBO thought that CMMI would continue to find models that reduced spending, but after the first two models were certified, the rate of certification declined over time. Second, CMMI models are largely voluntary, meaning providers can choose models that have positive financial outcomes and drop models that have the opposite effect. CMMI has discussed implementing mandatory participation for this reason. Third, CBO said it did not realize CMMI models would contradict within health systems, creating conflicts for providers, as well as payment policy changes.
 
Several days before the CBO report was released, Senate Budget Committee members briefly praised the CMMI for working to lower spending, prematurely praising CMMI during a hearing on Medicare solvency when it did not actually lower spending.
 
Blair Childs, president and CEO of healthcare communications company Childs and Associates and a senior executive advisor for Premier Inc., said the CBO report is “missing the forest for the trees.”
 
“We are undergoing a tectonic shift in the incentives in healthcare payment,” he said in a LinkedIn post. “This is due to a bipartisan movement to shift payment from fee-for-service to accountable, value-based care. CMMI is a key player in making that change a reality under traditional Medicare and Medicaid. While Washington skeptics don’t want to stick their heads out and attribute this spending decline to the movement to value-based care, I submit that, based on strong evidence, it is the dominant cause of this change.”

Diabetes Multiplies Hospital Admission Risk for Home Health Patients, Study Finds

McKnight’s / By Adam Healy
 
Home health patients with diabetes are three times more likely to be hospitalized than those without, according to a new study published in Nursing Outlook. 
 
Almost half of home health patients suffer from diabetes. According to the study, it is one of the most common chronic conditions among people in this population. Among 5,300 community-dwelling home health patients with diabetes, the study recorded a hospital admission rate of 29.5%, affected by risk factors such as past hospitalizations, decreased performance in activities 
of daily living, depression or unhealed acute injuries.
 
The researchers compared this to people with diabetes in assisted living. These people may struggle more with activities of daily living or have greater cognitive impairments, the study noted, but they had a lower rate of hospital readmission due to access to round-the-clock assistance, meaning they were able to receive more timely preventive care 
 
For home health patients, one of the best predictors of hospital readmission was whether a person had been hospitalized in the past six months. Home health patients who had been recently hospitalized were more than twice as likely to be readmitted. Another strong predictor was someone’s function completing activities of daily living. The participants who struggled to manage their daily activities were more likely to be hospitalized. 
 
Conditions such as depression, decreased cognitive function and unhealed acute injuries like ulcers were all found to impact people’s ability to manage activities of daily living. While assisted living patients had greater access to support for these conditions, home health patients who lack access faced a higher risk of hospitalization, according to the study. Therapy services and other health interventions can help manage these conditions and help prevent rehospitalization, the researchers noted. 
 
Other research has found that staffing problems in the home care industry may lead to discontinuity of care, which can increase a patient’s risk of hospital readmission.

President's Message

Posted: October 4, 2023

Last week, APTA released a ground-breaking report titled, “The Economic Value of Physical Therapy in the United States”. This report analyzed the savings per episode of care that physical therapy services yield for eight common conditions. Sophisticated economic modeling was used to determine the true value that physical therapy provides for conditions such as osteoarthritis of the knee, vascular claudication, fall prevention, low back pain, and cancer rehabilitation. Savings per episode of care for these conditions ranges from a few thousand dollars to upwards of ten thousand dollars.

The take home message from this important study is: “Choosing physical therapy helps Americans live better lives and could save the health care system millions of dollars annually, ultimately providing more resources for better services to individuals and communities nationwide. Physical therapy helps Americans avoid complications from surgeries, long recoveries, and the risks of overuse of prescribed opioids and other medications.” In other words, this scientific work proves what we have been saying for years.

This study was funded by APTA (your dues at work!) and led by a group of physical therapists, including APTA Home Health member Jason Falvey, PT, DPT, PhD. Included in the report is a list of several more common health conditions that have been identified for inclusion in later versions of this report pending staffing, funding, and improved evidence around each condition.

You can find more information and download your own copy of this study at http://valueofpt.com.

Sincerely, 

Phil Goldsmith
President
APTA Home Health 

Government Shutdown Averted with Little Time to Spare as Biden Signs Funding Before Midnight

AP News | By Lisa Mascaro, Kevin Freking and Stephen Groves

WASHINGTON (AP) — The threat of a federal government shutdown suddenly lifted late Saturday as President Joe Biden signed a temporary funding bill to keep agencies open with little time to spare after Congress rushed to approve the bipartisan deal.

The package drops aid to Ukraine, a White House priority opposed by a growing number of GOP lawmakers, but increases federal disaster assistance by $16 billion, meeting Biden’s full request. The bill funds government until Nov. 17.

After chaotic days of turmoil in the House, Speaker Kevin McCarthy abruptly abandoned demands for steep spending cuts from his right flank and instead relied on Democrats to pass the bill, at risk to his own job. The Senate followed with final passage closing a whirlwind day at the Capitol.

“This is good news for the American people,” Biden said in a statement.

He also said the United States “cannot under any circumstances allow American support for Ukraine to be interrupted” and expected McCarthy “will keep his commitment to the people of Ukraine and secure passage of the support needed to help Ukraine at this critical moment.”

It’s been a sudden head-spinning turn of events in Congress ahead of the midnight funding deadline after grueling days in the House pushed the government to the brink of a disruptive federal shutdown.

The outcome ends, for now, the threat of a shutdown, but the reprieve may be short-lived. Congress will again need to fund the government in coming weeks risking a crisis as views are hardening, particularly among the right-flank lawmakers whose demands were ultimately swept aside this time in favor of a more bipartisan approach.

“We’re going to do our job,” McCarthy, R-Calif., said before the House vote. “We’re going to be adults in the room. And we’re going to keep government open.”

If no deal was in place before Sunday, federal workers would have faced furloughs, more than 2 million active-duty and reserve military troops would have had to work without pay and programs and services that Americans rely on from coast to coast would have begun to face shutdown disruptions.

“It has been a day full of twists and turns, but the American people can breathe a sigh of relief: There will be no government shutdown,” said Senate Majority Leader Chuck Schumer, D-N.Y.

The package funds government at current 2023 levels until mid-November, and also extends other provisions, including for the Federal Aviation Administration. The package was approved by the House 335-91, with most Republicans and almost all Democrats supporting. Senate passage came by an 88-9 vote.

Read Full Article