Report: CMMI has Raised Federal Spending, Not Lowered it

Fierce Healthcare | By Noah Tong
 
The Center for Medicare and Medicaid Innovation (CMMI), once expected to save money and deliver healthcare at a lower cost, is increasing federal spending after all.
 
A report from the Congressional Budget Office (CBO) shows that the office increased direct spending by $5.4 billion between 2011 and 2020. CMMI spent $7.9 billion to operate models, but those models only reduced healthcare benefits spending by $2.6 billion.
 
The new figures reflect a stark contrast from CBO’s projections when the Affordable Care Act (and CMMI) was first enacted. CBO believed at the time that CMMI would reduce spending by $2.8 billion and lower spending on benefits by $10.3 billion, offsetting the $7.5 billion needed to operate CMMI’s models.
 
CBO now anticipates spending will increase an additional $1.3 billion from 2021 to 2030, though the office notes that the “budgetary effects of CMMI’s activities over the first decade and its updated projects are subject to considerable uncertainty.” For example, the report did not capture savings that were gained by accountable care organizations (ACOs) through the Medicare Shared Savings Program.
 
The agency believes that its incorrect projections can be attributed to several factors.
One, CBO thought that CMMI would continue to find models that reduced spending, but after the first two models were certified, the rate of certification declined over time. Second, CMMI models are largely voluntary, meaning providers can choose models that have positive financial outcomes and drop models that have the opposite effect. CMMI has discussed implementing mandatory participation for this reason. Third, CBO said it did not realize CMMI models would contradict within health systems, creating conflicts for providers, as well as payment policy changes.
 
Several days before the CBO report was released, Senate Budget Committee members briefly praised the CMMI for working to lower spending, prematurely praising CMMI during a hearing on Medicare solvency when it did not actually lower spending.
 
Blair Childs, president and CEO of healthcare communications company Childs and Associates and a senior executive advisor for Premier Inc., said the CBO report is “missing the forest for the trees.”
 
“We are undergoing a tectonic shift in the incentives in healthcare payment,” he said in a LinkedIn post. “This is due to a bipartisan movement to shift payment from fee-for-service to accountable, value-based care. CMMI is a key player in making that change a reality under traditional Medicare and Medicaid. While Washington skeptics don’t want to stick their heads out and attribute this spending decline to the movement to value-based care, I submit that, based on strong evidence, it is the dominant cause of this change.”

Diabetes Multiplies Hospital Admission Risk for Home Health Patients, Study Finds

McKnight’s | By Adam Healy
 
Home health patients with diabetes are three times more likely to be hospitalized than those without, according to a new study published in Nursing Outlook. 
 
Almost half of home health patients suffer from diabetes. According to the study, it is one of the most common chronic conditions among people in this population. Among 5,300 community-dwelling home health patients with diabetes, the study recorded a hospital admission rate of 29.5%, affected by risk factors such as past hospitalizations, decreased performance in activities 
of daily living, depression or unhealed acute injuries.
 
The researchers compared this to people with diabetes in assisted living. These people may struggle more with activities of daily living or have greater cognitive impairments, the study noted, but they had a lower rate of hospital readmission due to access to round-the-clock assistance, meaning they were able to receive more timely preventive care 
 
For home health patients, one of the best predictors of hospital readmission was whether a person had been hospitalized in the past six months. Home health patients who had been recently hospitalized were more than twice as likely to be readmitted. Another strong predictor was someone’s function completing activities of daily living. The participants who struggled to manage their daily activities were more likely to be hospitalized. 
 
Conditions such as depression, decreased cognitive function and unhealed acute injuries like ulcers were all found to impact people’s ability to manage activities of daily living. While assisted living patients had greater access to support for these conditions, home health patients who lack access faced a higher risk of hospitalization, according to the study. Therapy services and other health interventions can help manage these conditions and help prevent rehospitalization, the researchers noted. 
 
Other research has found that staffing problems in the home care industry may lead to discontinuity of care, which can increase a patient’s risk of hospital readmission.

Report: Engaging Family Caregivers, Diversifying Referral Mix are Keys to Sustainability

Home Health Care News | By Patrick Filibin
 
Home-based care providers have an opportunity to differentiate themselves by honing in on what they’re great at.
 
A number of factors are transforming the environment in which home-based care providers operate: the rise of value-based care, regulatory scrutiny, reimbursement falling behind rising costs and staffing shortages.
 
Amid all of that, more than ever, providers need to sell their worth.
 
“Whether it’s value-based care, talking about diversifying risk or other factors, the opportunity to meaningfully differentiate an organization through the lens of its strengths is actually a tremendous opportunity for smaller providers to compete against larger ones,” Transcend Strategy Group President and CEO Stephanie Johnston told Home Health Care News.
 
In a new research report, Johnson and her colleagues outlined a number of potential strategies that providers can follow to be better equipped for change in home-based care.
 
It’s no longer enough for agencies to trust that high-quality care and word-of-mouth reputation alone will sustain their businesses, the report argues.
 
In order for agencies to thrive today and in the future, a strong value proposition to payers is a critical aspect of an agency’s business operation. In particular, having a diversified referral mix could be a core component for driving sustainability.
 
“Way too often — and still recently — we hear people tell us that they are still relying on a primary referral source to drive volume,” Johnston said. “Basic risk management will tell you that [strategy] is too risky for today’s care providers at home. They need to think about diversifying their referral mix.”
 
Johnston compared it to an investment portfolio. Logic would tell an investor not to go all in on one investment asset. Instead, one would manage risk across multiple assets.
 
“That’s exactly what home care providers should do,” Johnston said. “They should think about a referral portfolio that they’re managing that should include relationships with physicians, hospitals, SNFs and patients and families themselves.”
 
Relying on hospitals as a primary referral source, where highly acute patients are likely to come from, can create unwanted exposure when staffing becomes a problem, for instance.
From a staffing perspective, Transcend’s report also encourages providers to embrace family caregivers. Many providers, the report argues, are focusing on fighting for the same pieces of the pie.
 
By looking outside the box and welcoming family caregivers into the employee fold, the pie can be expanded.

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For Home Care Providers, HCBS Operating Environments Still Vary Greatly From State to State

Home Health Care News | By Joyce Famakinwa
 
More than three years after the start of the COVID-19 pandemic, the U.S. is still seeing major gaps in long-term care for seniors, according to a new AARP report. 
 
“We know that some states are taking steps to innovate or put new policies in place, such as paid leave for family caregivers, or a payroll tax credit for family caregivers, but state action is generally falling short of what the aging populations in these states need, so that people can live their final years or even decades in dignity with access to the best care possible,” Susan Reinhard, senior vice president of AARP Public Policy Institute, said during a Thursday press call.

The report found that 53% of Medicaid long-term services and support spending for seniors and adults with physical disabilities went to home- and community-based services.
 
Plus, 12 states spent the majority of Medicaid long-term services and support funding on home- and community-based services. This is an increase from seven states in 2009.
 
Family caregivers were also a big focus area of the AARP report. 
 
“No.1 is prioritizing family caregivers — 48 million family caregivers who really are the backbone of the long-term care system,” Reinhard said. “They are providing more than $600 billion in unpaid care. They need help – paid sick leave, tax credits and other mechanisms to address the family caregivers’ health and financial needs, so that they can stay on the job, frankly.”
 
The report concluded that states that had policies meant to support family caregivers needed to maintain their policy framework, but also make sure that those policies were effectively implemented. It also found that states with strong family caregiver supports in place tended to have better overall long-term services and support systems. 
 
The report also dug into the home- and community-based care infrastructure. 
 
“It’s important to address a whole infrastructure, such as increasing support and training for home health aides for home visits, supporting the ability to access and use medical devices and equipment, and most important is updating key Medicaid regulations and payment models,” Reinhard said.
 
AARP found that between 2018 and 2020, 21 states improved their Medicaid spending balance by 10% or more, while 6 other states declined by at least 10% during that time period.
 
The report found that 23 states saw a 10% or more increase in home care costs. Inflation, growing demand and consumer preference for home care over nursing homes are some of the contributing factors to these higher costs.
 
Additionally, 16 states saw a 10% or more decrease in home health aide supply, while 18 states saw a 10% or more increase.
 
Ultimately, Reinhard stressed the importance of enhancing long-term care support and services for seniors. 
 
“It’s really critical that we improve the aging experience for all Americans across the country,” she said. “Our ability to get this right largely depends on our ability to care for our loved ones … that requires providing both humane and holistic long-term care support and services.”
 
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