Our weekly list of news, reports, and information about home health and hospice care. Learn about new studies, trends, CMS regulations and more.
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The Patient-Driven Groupings Model (PDGM) is a perfect storm of regulatory and reimbursement changes, according to top executives from Amedisys Inc. (Nasdaq: AMED), Encompass Health Corporation (NYSE: EHC) and LHC Group Inc. (Nasdaq: LHCG). For agencies, managing cash flow and making sure staff are operating at the top of their licenses will be keys to survival. April Anthony, CEO of Encompass Health’s home health and hospice segment, discussed the two points Wednesday during a presentation at the 2019 Home Health Care News Summit in Chicago. She was joined by Amedisys President and CEO Paul Kusserow, in addition to LHC Group Chairman and CEO Keith Myers.
Keith Myers co-founded LHC Group (NASDAQ: LHCG) in 1994 and has served as its chairman and CEO ever since. Today, the company’s platform, including all service lines, reaches 60% of the U.S. population aged 65 and older, LHC Group reported in an August earnings call. One of the largest hospice and home health providers in the nation, the Lafayette, La.-based company operates 104 hospice locations, two hospice inpatient units and four palliative care programs in 35 states and the District of Columbia, caring for upwards of 21,000 patients and representing 11% of LHC Group’s business. The company’s hospice segment earned nearly $55.1 million in net service revenue during the second quarter of this year, up from close to $50.1 million in Q2 2018.
The U.S. Centers for Medicare & Medicaid Services (CMS) is experimenting with the concept of including hospice in value-based payment models, as evidenced by the forthcoming Medicare Advantage carve-in, the Medicare Care Choices model and the Primary Care First initiative. While the agency has no immediate plans to transform the Medicare Hospice Benefit’s per diem payment model, opportunities for hospice to enter value-based payment programs will likely proliferate in years to come. The goal of value-based care models is to improve the quality of care while also reducing costs. In value-based purchasing, payers, including Medicare, create financial incentives to health care providers for achieving a certain level of performance on specific quality measures, typically process measures. In some models payers apply penalties or other disincentives for poor performance or poor outcomes. A transition to a value-based system would pose challenges and present opportunities for hospice providers, negotiations with payers may reduce reimbursement dollar amounts, but providers may be able to engage with patients earlier in the continuum of care, with longer lengths of stay potentially offsetting any payment reductions.