Medicare Expansion Would Have Limited Impact on Home Health Providers

More than half of large employers in the U.S. are in favor of expanding Medicare to Americans under 65 — a change that, if implemented, could give government-reimbursed home-based care providers access to more patients. That’s according to a study from the National Business Group on Health, first covered in Forbes. The survey included responses […]

NAHC’s Dombi: CMS Putting Home Health Providers Under the Gun

Home health providers are under more pressure today than arguably ever before. The immediate battle remains the Patient-Driven Groupings Model (PDGM), which could pose an 8.01% cut to providers if its assumption-based behavior adjustments aren’t addressed through Congressional action. But there are plenty of smaller skirmishes taking place in the background as well, according to […]

Why Home Health Care’s Experience Casts Doubt on a Hospice MA Carve-In

The Centers for Medicare & Medicaid Services (CMS) made waves in January when it unveiled plans to test a hospice carve-in under Medicare Advantage (MA), a step long viewed as “inevitable.” Specifically, CMS officials said they would test the feasibility of a hospice carve-in starting in 2021 through the MA Value-Based Insurance Design (VBID) model. […]

CMS Proposal Takes Home Health Agency Closure Estimates and ‘Lights Them on Fire’

After federal health care policymakers fine-tuned the Patient-Driven Groupings Model (PDGM) last October with a 6.42% cut based on certain behavioral assumptions, some industry experts predicted there would be a modest uptick in home health bankruptcies in 2020. “The last time the industry went through this kind of major change was in the late 1990s […]

Game On: PDGM Encourages Home Health Agencies to ‘Game the System’

When the Center for Medicare & Medicaid Services (CMS) developed the Patient-Driven Groupings Model (PDGM), part of the goal was to fix problems that exist with the currently used Prospective Payment System (PPS). One such problem, government watchdogs say, is agencies prioritizing quantity of care over quality because it often leads to more money. Thus, […]

CMS Finding New Ways to Penalize Home Health Providers

The Centers for Medicare & Medicaid Services (CMS) is finding new ways to penalize home health providers. In its proposed payment rule for 2020 released last week, CMS floated the idea of phasing out pre-payments for home health services starting in 2020, killing them completely by the following year. Currently, home health providers can receive […]

NAHC’s Dombi: CMS Needs to ‘Back Off’ RAP Proposal, PDGM Assumptions

The looming Patient-Driven Groupings Model (PDGM), a potential hospice carve-in under Medicare Advantage (MA) and the expanding Review Choice Demonstration (RCD) are just a few of the developments reshaping the current landscape of home health and hospice. As if those three items aren’t enough, providers are also facing the continuing Value-Based Purchasing Model (VBPM), emerging […]

CMS’s Proposal to Eliminate RAPs, Increase PDGM’s Behavioral Adjustment ‘Death by 1,000 Cuts’

Home health operators and industry advocates are voicing their concerns following a proposal from the Centers for Medicare & Medicaid Services (CMS) to eliminate home health pre-payments and move forward with behavioral assumptions under the Patient-Driven Groupings Model (PDGM). Specifically, many worry the proposed changes will create cash flow problems for home health agencies, which […]

Home-Based Care Ally Adam Boehler to Leave CMMI

A key ally for home health providers and a major proponent of value-based care may be leaving his federal post. The Trump administration revealed late Wednesday it has nominated Adam Boehler — director of the Center for Medicare & Medicaid Innovation (CMMI) and a senior adviser to the secretary of the U.S. Department of Health […]