How CMS’ Goal To Enroll All Medicare Beneficiaries In ACOs Could Impact Home-Based Care Providers

Home Health Care News | By Joyce Famakinwa
 
The U.S. Centers for Medicare & Medicaid Services (CMS) has stated its objective to enroll all of its Medicare beneficiaries in accountable care relationships by 2030.
 
Currently, roughly 13.2 million Medicare fee-for-service beneficiaries are assigned to an ACO. 
With this in mind, there has been more activity and investment around accountable care organizations (ACOs), including for at-home care providers, which are strategically collaborating with these organizations.
 
The Walgreens Boots Alliance-backed VillageMD — a Chicago-based primary care services organization that has an at-home care arm — is one provider that is working heavily in the ACO space. The company is a participant in the ACO REACH Model, for example. 
 
Andrea Osborne, senior vice president of ACO operations and delegated services at VillageMD, pointed out that the ACO REACH model allows providers more leg room to approach CMS about various concerns and suggestions.
 
“We actually get to go to CMS and have conversations, and say, ‘Hey, the Medicare rule isn’t working for us,’” she said Tuesday during a panel discussion at the annual LeadingAge conference in Chicago. “‘We’d like to try it that way.’ We have these conversations.”
Amid the pandemic, the company approached CMS about expanding at-home care services, for instance.
 
“We said, ‘We want to be able to use home health care anywhere,’ and then they actually ended up opening that up for everyone,” Osborne said. “That’s because we had tested these models, so it’s really important that when you are in these partnerships – if there are barriers to care that are Medicare regulations – you’re speaking with your ACO partner, because we actually can get opportunities to test changing those rules.”
 
Medicare Shared Savings Program (MSSP) ACOs are an opportunity for home-based care providers to enter the space.
 
The majority of MSSP ACOs are hospital-based. As a result, these ACOs are focused on a patients’ post-acute stay after a hospitalization, according to Andy Edeburn, a consultant at Elder Dynamics, an advisory services company for aging services providers.
 
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‘Do The Homework’: What Home Health Providers Need To Know Before Sitting Down With Payers

Home Health Care News | By Patrick Filibin
 
Diving into value-based arrangements with payers always sounds good, in theory, for home health providers.
 
But it is easier said than done. Providers have to commit to value-based care, but even before that, they need to do their homework to be successful over the long haul.
 
Moving away from fee-for-service and moving toward risk through value-based arrangements takes a tremendous amount of research, operational awareness and financial investment.
 
It also requires legwork before, during and after negotiations with payers.
 
“In my experience, what happens so often is that providers get brought into these conversations without doing their homework first,” Fred Bentley, managing director at ATI Advisory, told Home Health Care News. “All of a sudden, they’re at the table and they think, ‘Let’s wing it.’ Or they will let the payer dictate the conversation, and the provider is just in reaction mode.”
 
What providers can do
 
Before sitting down at the table with payers, providers should clearly understand their goals. It may seem like a no-brainer, Bentley said, but it’s often an overlooked aspect of the process.
“It sounds so obvious, but ask yourself, ‘As a home health provider, what are we trying to achieve here?’” Bentley said. “There are different objectives. It can split into two paths: are you looking to grow your core business and are you using value-based care as a tool to be a more preferred critical partner in the eyes of the payer? And, it’s not mutually exclusive, but on the flip side, do you see real revenue upside?”
 
It’s quantitative versus qualitative, Nick Seabrook, managing principal at SimiTree, told HHCN.
“What do you want to get out of this?” Seabrook said. “You can get into it from a dollar and cents standpoint — prioritizing revenue. Or you can get into it with almost a marketing approach and say, ‘We have this relationship with a certain payer because we’re succeeding in this,’ and that could open the door to other referral sources.”
 
Also in order: a brutally honest look at what a provider’s value proposition is.
 
One of the challenges home health faces in particular, Bentley said, is that they are late to the game.
 
“They’re not out of the picture, but it’s not uncommon for payers to say, ‘We empower the primary care doctors and shift the risk to them — what can home health bring to the table?’” Bentley said. “That’s when you find your value prop — providers should have a painfully honest discussion about what they could bring to a Humana, for instance. What is it that you bring to the table, and how do you convince them that you’re ready for this?”…

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CMS Seems Intent On Sticking With Home Health Care’s Review Choice Demonstration

Home Health Care News | By Andrew Donlan
 
The Review Choice Demonstration (RCD) has received a set of diverse reactions since it has been live. Some home health providers find it useful and others find it to be yet another administrative burden. 
 
Either way, the U.S. Centers for Medicare & Medicaid Services (CMS) seems intent on expanding it. 
 
Broadly, the goal of RCD is to reduce improper billing in home health care. Illinois, Ohio, Texas, Florida and North Carolina providers have all participated at this point. An expanded implementation drew major criticism in some states, particularly during COVID-19. 
 
Now, the worst of COVID-19 has passed, and CMS is continuing its expansion of the demonstration, this time in Oklahoma. That will start in less than a month, on Dec. 1, 2023. 
“The choice selection period for Oklahoma will begin on Oct. 16, 2023, and will remain open until November 15, 2023,” Emily Richmond, who works on RCD for the Center for Program Integrity, said on a recent home health stakeholder call hosted by CMS. “Home health providers in Oklahoma can select from pre-claim review, post payment review, or a minimal post payment review with a 25% payment reduction, which means 100% of those claims have a 25% payment reduction.”
 
Meanwhile, the demonstration is set to expire in other states on May 31, 2024. CMS is currently considering extending it, though. 
 
“At this time, we have the demonstration set to end in May of 2024, but CMS is currently working internally to determine if the demonstration will be extended past that May expiration date, and we will definitely provide ample notice,” Jessica Czulewicz, who also works on RCD, said during the call. “At this point, that’s about the best answer I can give.”
 
Multiple sources have told Home Health Care News that they believe CMS is bullish on RCD and plans to continue expanding it. 
 
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Hospice from a Naturopathic Lens with CDPHE

Thursday, Nov 30  (2:00 –3:00pm MT)

Many fields of Western medicine have begun incorporating integrative therapies alongside more conventional practices, including within the field of hospice. Naturopathic doctors who have a background in both Western and integrative medicine are well-positioned to assist hospice teams and practitioners with a unique understanding of this shift as it relates to end-of-life and palliative care. This presentation, Hospice from a Naturopathic Lens, will discuss who naturopathic physicians are, the intersections of hospice care and naturopathic medicine, possible roles naturopathic doctors could play within hospice, various integrative therapies for common conditions, and finally, a short summary of the hospice survey process.

Presenter Information: Emily Keranen, ND is a health compliance inspector. Prior to joining the Colorado Department of Public Health (CDPHE), she worked as a physician in Arizona, with a focus on integrative thyroid medicine. In her spare time, she enjoys trail running, hiking, and triathlons. 

Google Meet joining info

Video call link: https://meet.google.com/wrb-ohvh-zoq 

Or dial: +1 567-707-0098 (PIN: 676382782)

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