Home Health & Hospice Week

More information about the Direct Contracting payment model is coming up.

Reminder: Under the model, Medicare may allow Medicare Advantage plans to use certain flexibilities such as permitting nurse practitioners to certify home health services, waiving homebound requirements, and covering concurrent (curative) care for hospice beneficiaries.

After its initial overview webinars on Jan. 7 and Jan. 8, the Centers for Medicare & Medicaid Services is now offering webinars and “office hours” on model facets including risk sharing, cash flow, quality, and more topics in January and February. Registration will be posted at https://innovation.cms.gov/initiatives/direct-contracting-model-options as it opens — scroll down to the “Information for Interested Stakeholders” section.

Reservations: While CMS continues to push for Medicare Advantage-related payment models, they may not be good news for providers — or patients. A JAMA Network Open study of more than 4 million home health agency admissions found that “Medicare Advantage beneficiaries were signif­icantly less likely than traditional Medicare benefi­ciaries to receive treatment from high-quality home health agencies.” Relative to traditional Medicare beneficiaries, the rate of receiving high-quality HHA care was 4.9 percentage points lower for those enrolled in “low-quality Medicare Advantage plans” and 2.8 percentage points lower for those in high-quality MA plans, said the study published last September.

Study author Margot Schwartz, a researcher at Brown University in Providence, Rhode Island, told Reuters that more MA members may end up with low-quality HHAs because if “limited networks” of available agencies.

Some higher-quality agencies may opt not to participate in MA plans because of low reimbursement rates, said study author Momotazur Rahman, also at Brown. “Payment rates by Medicare Advantage plans to home health agencies are much lower compared to traditional Medicare payment rates,” Rahman told the news service.

The study findings are concerning, especially considering MA’s increasing market share. The proportion of Medicare beneficiaries enrolled in Medicare Advantage increased from 13 percent in 2004 to 33 percent in 2017, according to the study at https://jamanetwork.com/journals/jamanet workopen/fullarticle/2749236.