The home health, home care and hospice industries experienced ups and downs in 2018, including regulatory surprises, new business opportunities and industry-shaping mega deals. Home Health Care News was there to cover it all.
Revisit 2018 — and get a sense of what ongoing trends and regulations will shape 2019 — by reading through our 11 most-read stories from the past year:
Toward the beginning of the year, the U.S. Centers for Medicare & Medicaid Services (CMS) announced that — for the first time — certain non-skilled in-home services would be allowed as supplemental benefits under Medicare Advantage (MA) plans starting in 2019. Home care providers have been trying to navigate what the rule change means for them ever since. Several of HHCN’s top stories were MA-related.
Similar to MA stories, HHCN’s home health readers were obviously eager to learn how the Patient-Driven Groupings Model (PDGM) would impact them. CMS finalized the payment overhaul — the biggest the industry has seen in years — at the end of October. While finalized, Congress could still call for PDGM changes, as stakeholders remain concerned about key provisions related to coding and low utilization payment adjustments (LUPAs), among other areas.
The Pre-Claim Review Demonstration (PCRD) is dead. Long live the Review Choice Demonstration (RCD). After fighting off PCRD in Illinois, CMS renewed efforts to combat improper billing by proposing RCD, a similar initiative with added flexibility for home health agencies. RCD was supposed to take effect in Illinois on Dec. 10, but was delayed.
Humana Chief Medical Officer Roy A. Beveridge took to HHCN to explain how Humana plans to keep older adults living with multiple chronic conditions out of the hospital and in their homes. Several top HHCN stories focused on Humana, as seen in the items below.
In April, news broke that insurance giant Humana (NYSE: HUM) and two private equity firms — TPG Capital and Welsh, Carson, Anderson & Stowe (WCAS) — planned to acquire privately held hospice operator Curo Health Services for about $1.4 billion. The deal closed in July.
Also in April, rumors swirled that Humana was in early talks to be acquired by retail behemouth Walmart (NYSE: WMT). At least so far, that has not come to pass, and appears unlikely.
7. March 26 — Senior Helpers to Staff First U.S. Dementia Village
Major national home care franchiser Senior Helpers was tapped to staff the first U.S. version of a “dementia village” as part of a model known as “Town Square.” Later in the year, Senior Helpers announced it would franchise the model, a simulated town designed for reminiscence therapy for older adults who lived in the 1950s.
In the first quarter of 2018, Great Lakes Caring, National Home Health Care and Jordan Health Services announced they were combining in a three-way mega merger. The combined enterprise — which serves more than 65,000 patients daily across 16 states — was ultimately named Elara Caring.
HHCN broke down three of the lesser-known aspects of PDGM.
HHCN caught up with David Baiada at the company’s global support center. In a candid conversation, Baiada discussed his first months in the CEO role, the state of play in the home health industry and the entrance of tech-forward startups with large venture capital funding.
11. June 24 — OIG Puts the Pressure on as Hospice Fraud Cases Pile Up
As utilization has increased and companies have more widely shifted toward high-margin profit models, claims of fraud, waste and abuse in the hospice industry have become increasingly common. So much so, the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) has made hospice investigation a substantial portion of its active work plan.
Written by Robert Holly