Our weekly list of news, reports, and information about home health and hospice care. Learn about new studies, trends, CMS regulations and more.
Amedisys Inc. (Nasdaq: AMED) has locked in an agreement with ClearCare Inc. that will expand its personal care services and could open the door for future Medicare Advantage (MA) opportunities. The deal could also be good news for home care providers hoping to work with the home health giant. As one of the largest home health, hospice and personal care providers in the country, Baton Rouge, Louisiana-based Amedisys’ footprint spans 471 care centers in 38 states and the District of Columbia. San Francisco-based ClearCare provides caregiver scheduling, billing, and other software solutions to more than 4,000 home care agencies in total, including several of the industry’s largest.
Personal care aides are the fastest-growing job in Maryland as health care needs increase for the state’s aging population, but there are also concerns about the quality of that work. The number of personal care aides in Maryland has grown 330% over the last 10 years according to CommercialCafe. It is also the fastest-growing occupation nationally, growing 251%. That trend coincides with Maryland’s changing age demographics. The 80- to 89-year-old bracket is the fastest-growing segment of Maryland’s population and the boomer generation has mostly aged into retirement.
CMS Proposes New Home Health Agency Rule Including Potential Changes to Reimbursement, Coverage, Quality, and More: CMS Accepting Comments Until September 9, 2019
On July 11, 2019, the Centers for Medicare and Medicaid Services (“CMS”) announced a proposed rule for home health agency Medicare reimbursement that would increase payments by an aggregate 1.3% for 2020, amounting to $250 million. In doing so, CMS would begin a transition to payments that are value-based, implementing the Patient-Driven Groupings Model (“PDGM”), an alternate case-mix payment methodology. In the PDGM, home health agencies are paid for 30 rather than 60-day episodes of care, and reimbursement is based on patient characteristics rather than the number of therapy visits provided. In a statement from CMS administrator Seema Verma regarding the proposed rule, she said the PDGM will reward “value over volume.” The proposed changes to reimbursement also include a one-year phasing out of pre-payments for home health services, known as Requests for Anticipated Payment. These proposed changes reflect a significant shift in the manner in which home health agencies historically have been reimbursed.
Regulators have been zeroing in on hospice providers in recent years as utilization and expenditures continue to rise. Deficiencies in care planning is one area that is attracting increasing attention. A recent report from the U.S.Department of Health and Human Services Office of the Inspector General (OIG) indicated that more than 87% of the 4,563 hospices operating in the United States between 2012 and 2016 had at least one instance of noncompliance with quality, administrative and safety standards set by the U.S. Centers for Medicare & Medicaid Services (CMS).