CMS Releases Preview of Home Health Value-Based Purchasing Performance Reports

McKnight’s Home Care | By Adam Healy
 
Providers can now examine their Preview Annual Performance Reports for the Home Health Value-Based Purchasing (HHVBP) model, which will be crucial for determining potential reimbursement changes taking effect next year, according to home care consulting firm Healthcare Provider Solutions.
 
“This preview report introduces, for the first time, the percentage calculations showing how your 2023 results will affect your 2025 payments,” Melinda Gaboury, the cofounder and chief executive officer of Healthcare Provider Solutions, explained Monday. “It’s crucial that you review these reports right away, especially if you’ve been monitoring your calculations and believe there may be errors.” 
 
The Centers for Medicare & Medicaid Services uses claims data, Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) surveys and Outcome and Assessment Information Set (OASIS) results to score providers under HHVBP. Those who rank within the 51st percentile or higher will see either no change in their future reimbursement or a payment increase of up to 5%. However, providers that are scored at the 50th percentile and below will have their payment reduced between 0.2% and 5%. 
“Make sure to thoroughly review the content, especially focusing on the measures where your performance has fallen short,” Gaboury recommended. “As you review each individual element and its percentile ranking, aim for each measure to fall within the 50th to 75th percentiles to ensure your overall score is moving in the right direction.”
 
Experts recently offered strategies for achieving the best results under HHVBP at the National Association for Home Care & Hospice’s 2024 Financial Management Conference in Las Vegas. The most important quality measure affecting providers’ HHVBP scores is their rate of acute care hospitalization claims, so using tools like remote patient monitoring can help rein in avoidable hospitalizations, they said.
 
CMS is accepting requests for score recalculations up to Sept. 7, Gaboury noted. On Sept. 27, CMS is expected to release Preliminary Annual Performance reports, and on Dec. 2, it will send out the final reports. The reports are available in the Internet Quality Improvement & Evaluation System (iQIES), according to CMS.

Medicare Advantage Vendors Brace for Supplemental Benefits Cuts

Modern Healthcare | By Lauren Berryman
 
Companies that have profited from the largesse of Medicare Advantage insurers seeking to lure customers with generous perks are looking ahead to a tough 2025.
 
Humana and CVS Health subsidiary Aetna are among those signaling that curtailing supplemental benefits such as transportation, fitness memberships, in-home support services, and vision, dental and hearing coverage will be a key part of their strategies to restore margins in a business troubled by high costs and a more restrictive regulatory environment.
 
Related: What insurers got wrong about Medicare Advantage costs
 
Take Modivcare, which provides remote patient monitoring and non-emergency medical transportation for Medicare Advantage members. The publicly traded company, which also contracts with states and Medicaid insurers, relies on Medicare Advantage for about one-fifth of its revenue, said Seth Ravine, chief commercial officer. But that could change next year as insurers reevaluate supplemental benefits.
 
“The reality for the MA plans is they can't do everything for everyone with fixed financial constraints or on a fixed budget,” Ravine said.
 
If the company's insurer clients pull back from covering transportation, that would leave patients who can't get to their medical appointments in the lurch, he said.
 
Aetna and Humana confirmed on their most recent earnings calls that they’ve taken actions to trim benefits next year. UnitedHealth Group and Elevance Health told investors that financial challenges have them scrutinizing which benefits that go beyond fee-for-service Medicare will remain next year.
 
“Those are putting a lot of financial pressure on plans’ margins and, as such, they just don't have as much money to invest in supplemental benefits in their bids this year as they have had in the past,” said Alexis Levy, senior partner at HealthScape Advisors, which is part of the Chartis Group, a consulting company.
 
That spells bad news for companies on the receiving end of the supplemental benefits boom, Levy said. “It could definitely be a financial headwind for vendors if they're starting to see some of their customers cut back,” she said.
 
Medicare Advantage insurers have had a challenging 18 months, leading some to misforecast expenses and overpromise to investors. Higher medical costs and utilization, changes to the Star Ratings program and risk-adjustment programs, and a small rate cut for 2025 have pushed the major for-profit carriers to take hard looks at their offerings and geographic footprints…

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Health Worker Shortages Forecast Thru 2028 

Axios | By Maya Goldman
 
Continued worker burnout and more demand for care from an aging population will drive health care workforce shortages into 2028 — though with significant variations by state, according to a Mercer analysis.
 
Why it matters: While there's been considerable attention paid to physician shortages, the analysis highlights an acute need for more nurse practitioners, even in states like California and Texas that will have overall surpluses of health workers.
 
By the numbers: The U.S. is expected to be short 100,000 health care workers by 2028, Mercer projects. 

• New York will be short about 61,000 health care workers, or a more than 4% gap between supply and demand. New Jersey, Tennessee, Georgia, and Florida could all be more than 10,000 workers short of meeting patient demand.
• North Dakota, meanwhile, will have a nearly 5% surplus of health care workers by 2028. California, Texas, and Pennsylvania are also expected to have significantly more health care workers than needed.

Zoom in: Most states should have enough registered nurses to meet patient needs in 2028, and the country as a whole is expected to have a surplus of 30,000 RNs that year.

• But nearly every state will be short of nurse practitioners, despite employment of NPs growing faster than nearly all other jobs, per the Bureau of Labor Statistics. Only 13 states will be able to meet the demand for nursing aides, according to the projection.
  
  
• Home health and personal care workers, who represent nearly one-quarter of the health workforce, are projected to exceed demand nationally by almost 48,000 workers, though shortages are expected in states including North Carolina and New York.

The big picture: Continued burnout among health care workers and non-competitive pay for some positions are colliding with increased demand for health care services as baby boomers age.

• The churn continues a trend that spiked during the COVID-19 pandemic in 2020 and in 2022 — particularly among women, workers with children, and marginalized racial groups, Mercer noted.
  
  
• The projections are based on publicly available workforce data and data provided to the company by analytics firm Lightcast.

MedPAC Encourages CMS to Begin Home Health Clawback Reductions ‘As Soon As Possible’

McKnight’s Home Care | By Adam Healy

While providers were dismayed to see the Centers for Medicare & Medicaid Services’ recent proposal to cut home health payment rates by 1.7%, the Medicare Payment Advisory Commission was disappointed that CMS did not take more drastic measures.
 
“The permanent reduction to the base rate proposed by CMS is lower than the update recommended by the Commission (−7%) as sufficient to maintain beneficiaries’ access to care,” the MedPAC wrote Thursday in a letter to CMS. “After applying CMS’s proposed update of 2.5%, the net adjustment to the base rate of 1.5% would leave FFS Medicare home health payment levels well above the cost of providing care to beneficiaries.”
 
MedPAC has long called for CMS to address what it perceives to be high margins generated by home health providers. In July, the commission reported that home health providers enjoyed aggregate Medicare margins exceeding 22% in 2022, having been paid “well in excess of their costs for more than 20 years.”
 
Meanwhile, home health providers have only seen Medicare rates decline in recent years. CMS cut home health rates by 3.925% in 2023 and 2.89% in 2024. Industry advocates have described the repeated reductions as “irrational.”
 
The industry also faces a looming temporary rate adjustment intended to claw back billions of dollars in overpayments related to the switch to the Patient-Driven Groupings Model. MedPAC urged CMS to begin recouping these funds as soon as possible.
 
“CMS has not yet indicated the policy or timing for implementation of the required $4.455 billion temporary adjustment, and it would be appropriate for CMS to make public its planned approach for implementing the temporary adjustment as soon as possible,” MedPAC wrote. “The Commission encourages CMS to begin the reductions required by the temporary adjustment as soon as possible. Taking this action would better align payments with costs and also reduce the temporary reductions necessary in future payment years.”