Volume 12, Number 13 February  1, 2023



Dear Healthcare at Home Colleague,

Medicare Advantage. Welcome words for some, nightmare for others. Last month's Home Care 100 conference was overwhelmed with the woes of underpayments, limitations on visit frequency, and additional rate cuts in 2024. But before we direct you to our report on what we heard at Home Care 100, there is a more pressing matter I would like to bring to your attention.

Kudos are in order to one of our industry's leading home telehealth providers. It is an inspiring story. We learned that one of our longtime consulting clients entered into a contract during the early days of the pandemic to provide telehealth services to the patients of a partner hospital. The Chicago-area home health agency was disappointed to learn that the hospital, though grateful for the ability to send Covid patients home early, was not open to sharing the savings accrued to them by the agency's remote patient monitoring investment. 

The agency found itself faced with the remaining months of a two-year contract, no reciprocal hospital compensation in sight, and a shrinking Covid census as the pandemic gradually eased. The financial burden was more than the agency could bear. That was when Jarrett Bauer, Co-Founder and Chairman of Health Recovery Solutions, stepped up, even though he did not have to. Overriding company policy, he convinced his team to forgive the remaining months of the contract, saving ASI Home Care from a deficit that would have ultimately harmed innumerable inner-city Chicago patients. 

 

 

Medicare Advantage

Even while agreeing that recruiting and retention of caregivers is healthcare's #1 problem, the topics in Orlando repeatedly turned to the inadequate payments doled out by insurance companies with Medicare Advantage contracts from CMS. Lured by celebrities in massive ad campaigns during daytime reruns of westerns and game shows, total MA enrollment will reach half of all Medicare beneficiaries later this year. MedPAC is not permitted to consider these losses when calculating Home Health traditional Medicare margins, and persists in its mistaken belief that those margins are the same as profit margins.

Scroll down to our headline list to find our reporting and analysis of the situation, as described by executives from Home Health and Home Care's largest providers, most reputable lobbyists, and respected thought leaders. Some carefully described the problem; others offered possible strategies to deal with it.

 

 

Guest author Wendell Potter brings his unique perspective to the discussion in a frankly worded piece about the harm Medicare Advantage is doing to patients and providers. It may be helpful to read his insider perspective before jumping into our recreations of the meeting's highlights. Mr. Potter was an insurance PR executive for most of his career, in charge of promoting Medicare Advantage policies and covering his employer's sins, before making a complete about-face and devoting recent years to making amends.

 

Tip

When you click on a headline below, you will be taken to our web site, where this week's stories and all articles since 2005 are stored and available. Eighteen years of The Rowan Report have created a treasury of industry news and analysis, which may be quite useful to newcomers learning our healthcare sector. To research our archives, use the Search function on the home page. Enter one to three key words and see what we have written on your favorite topics.

Have a great week. Keep making a difference!

Editor signature
Tim Rowan



Our Medicare Payment System is Broken
At Home Care 100, four top executives and one MedPAC commissioner agree. The formulae CMS use to calculate profit margins and determine rate cuts is "stupid."

Medicare Advantage Is Neither Medicare Nor an Advantage
Former insurance executive who used to sell Medicare Advantage explains why it is stealing from taxpayers and seniors.

When to Walk Away from MA
Theory about thriving in the current payer environment is helpful, but now we hear practical suggestions from those who have dared to tell MA insurance companies "not no but hell no."

CMS News: New Rule Cracks Down on Medicare Advantage Upcoding
— Risk Adjustment Data Validation (RADV) final rule strengthens Medicare Advantage and restores payment oversight program
— Expanded HHVBP Model: January 2023 PIPR Available in iQIES

Vendor Watch
— CareXM partners with MedLine
— CareAcademy acquires NextStep



During the 1st Quarter of 2023, web sites of the above advertisers were visited by home care and hospice executives and staff 4163 times.

To inquire about placing your message here, contact:

Kristin@rowanresources.com

As of this date, approximately 48,565,000 Baby Boomers have become Medicare eligible.

 

Last Week's Most-Read Stories:

Corridor Announces Acquisition of Select Data's Coding Services Business Unit
Select Data to turn its focus to "SmartCare," a new, AI-based, coder advisory system.

Prepare Your Agency for the Unexpected in 2023
We summarize the white paper released last week by AlayaCare CEO Adrian Schauer, with tips for thriving in an uncertain year.


Upcoming Events

 

Shine Your Light
Illinois HomeCare & Hospice Council Annual Meeting and Exposition

Dates: April 9-10
Venue: NIU Naperville

Information and Registration


FREE WEBINAR: CMS’ Proposed Hospice FY2024 Payment Rule: Implications for Agencies and the Hospice Community

Sponsored by NAHC
Featuring: Theresa Forster, Katie Wehri

Date: April 11
Time: 12:00 - 1:30 EDT

Details and Registration

 

Description: In addition to routine annual payment changes, CMS proposed FY2024 Hospice Payment Rule, issued on March 31, contains valuable updates on the Hospice Quality Reporting Program (HQRP). Perhaps most notable, the rule's deep dive into utilization trends signals an intensified interest in hospice care patterns, potentially inappropriate behavior in the hospice sector, and program integrity concerns.  Join two of NAHC's hospice experts as they detail proposed changes, including a new requirement that hospice certifying physicians be Medicare enrolled (or to have validly opted-out) and CMS' Requests for Information on hospice utilization and health equity, and examine their potential impact on hospice practice going forward.

Faculty: Theresa M. Forster, NAHC VP for Hospice Policy & Programs
Katie Wehri, NAHC Director of Home Health & Hospice Regulatory Affairs


WEBINAR: Audits: What to Do

A 90-minute Lunch & Learn Audio Conference by Elizabeth E. Hogue, Esq. Health Care Attorney

Date: Thursday, April 6
Time: 1:00 - 2:30 EDT

Encore date: April 13
On-demand recording available 24/7
Option to purchase recording and handouts

 

Information and Registration

 

Audio-Conference Description: Home care providers of all types; including home health agencies, private duty agencies, hospices and HME companies; remain targets of audits by various regulators, including but certainly not limited to United Program Integrity Contractors (UPICs). The results of these audits can be devastating because they may threaten the ability of providers to remain in business, especially when overpayments are extrapolated to millions of dollars. Audits of all types must be taken seriously and providers must take action to close audits as quickly as possible! The first thing providers must do is to review records requested by auditors.

The purpose of this teleconference is to give providers detailed steps to follow to avoid adverse consequences of audits. Examples of common issues targeted by auditors will be provided and there will be time for questions and answers.


 

First Joint Conference of the Carolinas

Association for Home & Hospice Care of North Carolina & South Carolina Home Care & Hospice Association

Dates: April 23-26

Venue: Westin

City: Charlotte

Information and Registration 



Rise Above!

Michigan Home Care & Hospice Association Annual Conference

Dates: May 3-5
Venue: Grand Traverse Resort & Spa

Registration and Information

The theme for the Conference is “RISE ABOVE” a fitting recognition of the challenges our industry and each of you overcame in your personal lives and professional careers to navigate the challenges of the past three years.

The MHHA conference presents an opportunity to meet new friends and reacquaint with peers. What better place to rise above, than at the spacious and beautiful Grand Traverse Resort & Spa? This conference has a little bit for every service line and discipline. Wednesday offers a track for Volunteer Managers and Thursday offers a track for Palliative Care as well as many other sessions for Certified Home Health, Hospice, DME and Private Duty Home Care.


2023 Annual Home Health & Hospice Conference
Homecare and Hospice Association of Utah

Date: May 10-11

City: Sandy

Attendee Registration

Exhibitor/Sponsor Registration


2023 Rocky Mountain Home Care, Home Health & Hospice Conference *Presented by: Home Care and Hospice Association of Colorado

Dates: May 18-19
Venue: Beaver Creek


Information and Registration for Attendees and Exhibitors


Home Care Innovation Forum*Presented by: The Influence Group

Dates: June 4-6
Venue: Park Hyatt Aviara 
City: 
Carlsbad, CA


Information and Registration

Featured Speakers:

Partial list of topics:


HI2: Home Care Innovation and Investment Conference *Presented by: Lincoln Healthcare Leadership

Dates: June 12-14
Venue: Swissotel 
City: 
Chicago


Information and Registration

Featured Speakers:


leading ONE vision

Homecare Homebase User Group Meeting

Dates: June 12-14
Venue: Sheraton Dallas Hotel

Information and Registration

Clinical Education Credits
Nationally recognized speakers, eight clinical sessions. Clinicians are encouraged to sign up for the clinical sessions, but are free to jump between clinical and non-clinical topics. Clinical topics include a homecare focus on Wound Care, Value Based Purchasing, Clinical Leadership, conflict resolution, Quality Report, Oasis and more.

Featured Speakers:



Your state or national association meeting or webinar not listed? Send the details to Conferences@RowanResources.com using this format:

Conference Title
Sponsoring Association
Date(s)
Hotel or Conference Center, City, State
URL



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