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.
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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.
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!
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
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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
Prepare Your Agency for the Unexpected in 2023
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Shine Your Light
Illinois HomeCare & Hospice Council Annual Meeting and ExpositionDates: April 9-10
Venue: NIU Naperville
FREE WEBINAR: CMS’ Proposed Hospice FY2024 Payment Rule: Implications for Agencies and the Hospice Community
Sponsored by NAHC
Featuring: Theresa Forster, Katie WehriDate: April 11
Details and Registration
Time: 12:00 - 1:30 EDT
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
Encore date: April 13
Time: 1:00 - 2:30 EDT
On-demand recording available 24/7
Option to purchase recording and handoutsInformation 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.
- What must providers do when reviews show deficiencies in documentation?
- When and how can providers amend or supplement records prior to submission to auditors?
- Should providers send summaries to auditors along with patient records?
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
Rise Above!
Michigan Home Care & Hospice Association Annual Conference
Dates: May 3-5
Venue: Grand Traverse Resort & SpaThe 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 UtahDate: May 10-11
City: Sandy
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
Home Care Innovation Forum*Presented by: The Influence Group
Dates: June 4-6
Venue: Park Hyatt Aviara
City: Carlsbad, CAFeatured Speakers:
- Mark King, CEO, Taco Bell
- Darryl "DMC" McDaniels
- David Causby, President & CEO, Gentiva
- Susan Benoit, CEO & President, CenterWell Home Health
- Bruce Greenstein, EVP, LHC Group
- Bill Dombi, President, NAHC
Partial list of topics:
- AI-enabled Remote Patient Monitoring
- Recruitment/Retention strategies
- AI and Automation for Better Hiring
- Developing an Effective MA Strategy
- The Future of Telehealth
- Taking on Risk
HI2: Home Care Innovation and Investment Conference *Presented by: Lincoln Healthcare Leadership
Dates: June 12-14
Venue: Swissotel
City: ChicagoFeatured Speakers:
- Vin Gupta, CMO, Amazon
- Patrick Conway, MD, CEO, Care Solutions
- Kevin Ban, MD, Global CMO, Walgreens
- Andy Slavitt, Founder, Town Hall Ventures, former CMS Administrator
leading ONE vision
Homecare Homebase User Group Meeting
Dates: June 12-14
Venue: Sheraton Dallas HotelClinical 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:
- Mark Scharenbroich: Award Winning Author, Emmy Award® Winner for an ABC TV special, National Speakers Association Hall of Fame Inductee, Golden Apple and Silver Screen Film award for his movie, "The Greatest Days of Your Life…(so far)," International film festival award winner.
- David Glickman: David has been a professional speaker and entertainer for over twenty years and has presented over 2000 programs. Before transitioning from "show business" to "speech business," he worked with everyone from Steve Martin to Ellen DeGeneres and performed at private parties for singer Gloria Estefan and former President Jimmy Carter. He also appeared on "Evening At The Improv" and several other national television shows.
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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