Preventable Hospitalizations Down Among American Seniors

According to a new report by the United Health Foundation on the state of seniors’ health, preventable hospitalizations have dropped. The third edition of its annual America’s Health Rankings Senior Report show “encouraging news for senior health nationally,” but also indicates the setbacks seniors have faced compared to previous years.

Among the major gains is a 6.8 percent reduction in preventable hospitalizations, a measure that’s also dropped 11 percent since 2013. Reasons for the reduced hospital admissions and readmissions include the push for better population health management and the shift from fee-for-service model to value-based payments.

The report also found a 9.3 percent increase in the number of home health workers year over year, and a 38 percent increase in seniors who choose hospice care at the end of their lives. These findings are supported by a recent report that indicated nursing homes may replace hospitals as the major providers of senior care – a trend that is fueled by the increased interest in palliative care.

Click here to see the report.

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MedPAC Calls For Cancellation Of Medicare Pay Raise For Nursing Homes

In a proposed rule published in the April 20 Federal Register, CMS said it is seeking a 1.4% net hike in the nursing home Medicare payment rate. The rate increase would reflect a market basket increase of 2.6% and two deductions, including a 0.6% cut for productivity adjustment and a 0.6% cut as a forecast error adjustment. However, in a letter to CMS, MedPAC has said that it believes no update is warranted because “Medicare’s current level of payments appears more than adequate to accommodate cost growth, even before any update.”

MedPAC argues that the aggregate Medicare margin for freestanding nursing homes in 2013 was 13.1%, the 14th consecutive year it exceeded 10%. However, the American Health Care Association is now shooting back at MedPAC’s decision, claiming MedPAC’s own research shows that nursing homes operate at an overall margin of only 1.9%.

MedPAC is now calling for CMS to move toward value-based purchasing and quality reporting programs. Additionally, MedPAC has recommended that Congress eliminate the market basket update, revise the prospective payment system, and rebase payments beginning with a 4% reduction to the base rate. Comments to CMS’ proposed rule are due on June 19.

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Tiptastic Tuesday: CMS Reminds Providers About New Survey Appeals Process

CMS has reminded state survey agency directors that it will no longer accept appeals through “the U.S. mail from providers that disagree with actions imposed on their facilities.” Providers must electronically file a hearing request using the Departmental Appeals Board e-filing system. Providers must also register on the DAB website.

Petitioners without access to the Internet or a computer may request a waiver from e-filing if they call the Civil Remedies Division at (202) 565-9462 and explain why.

The change became effective on October 1, 2014.

Click here to see the CMS memo.

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CMS To Remove Social Security Numbers From Medicare Beneficiary Cards

CMS has a new mandate to remove Social Security numbers from enrollees’ cards after being warned for more than 10 years by government investigators to remove them. The new requirement is part of a major Medicare payment reform bill signed in law just last week. CMS now has four years to begin issuing new Social Security cards without the numbers, and up to eight years to issue replacement cards to more than 50 million existing enrollees. The conversion is expected to cost $320 million and will be paid from Medicare trust funds. Social Security numbers on the Medicare cards will be replaced by a randomly generated identifier, according to officials.

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Tiptastic Tuesday: 5 Changes To Help Medicare ACOs Thrive

In order for the Medicare Shared Savings Program to reach its full potential, some key changes must be made, according to the authors in a recent Health Affairs blog post. Medicare ACOs have made progress on care quality and patient experience, however, only 1 in 4 MSSP ACOs have cut spending enough to share in overall savings.

According to authors in Health Affairs, the Medicare Shared Savings Program needs to make the following changes to truly thrive:

  • Increased certainty: A major issue with MSSPs is uncertainty. In order to correct this, CMS should transition to a benchmark calculation formula that combines ACOs’ historical spending and regional spending to eventually transition to a benchmark based completely on regional spending.
  • Clear definition of the transition away from fee-for-service: CMS should drive the transition with incentives greater than those for fee-for-service for organizations that demonstrate reduced costs and improved quality.
  • Alignment of MSSP with other Medicare reimbursement programs: In order to get MSSP and other Medicare alternative payment models on the same page, the authors recommend risk adjustment calculations, reporting mechanisms and requirements, and consistent quality measures.
  • Patient engagement: ACOs need more support to communicate and engage with their patients. The authors suggest expanding CMS’ pilot program for Pioneer ACOs’ “attestation models.”
  • Use of pointers from commercial ACOs: Many ACOs in the private sector have seen more success than those under Medicare by shifting away from fee-for-service with limited financial risk. CMS “should seek to reinforce those successful steps.”

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New QIO Report Highlights Nursing Homes’ Progress

A new progress report on CMS’ Quality Improvement Organization Program, a five-year project designed to enhance the quality of services for Medicare beneficiaries, notes key achievements since the implementation of the program. These achievements include significant reductions in adverse drug events, infections, wounds and use of restraints in nursing homes.

In August 2014, CMS redesigned the QIO program for which 5,000 nursing homes were recruited to participate. The following are some of the achievements among participating nursing homes:

  • 44,640 potential adverse drug events prevented
  • 3,374 pressure ulcers were prevented or healed in 787 facilities
  • 6,250 Medicare beneficiaries in 981 facilities are now restraint free
  • 85,149 fewer days with urinary catheters for Medicare beneficiaries.

The QIO program “hopes to unite nursing homes, key stakeholders and organizations throughout their communities to share tools, knowledge and technology to achieve system-wide improvement.” According to a recent Inspector General report, one in five nursing home residents suffer preventable harm.

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MedPAC May Stop Covering “Low Value” Procedures

The Medicare Payment Advisory Commission (MedPAC) is considering a plan that would stop covering “low value” procedures and tests due to their return on investment being too low. The procedures cost Medicare nearly $6 billion a year but yield little benefit, according to panel members. MedPAC came to this decision after exploring the results of 2012 analysis that found $5.8 billion in claims were paid that year for “low value procedures,” including a computed tomography for lung cancer and a prostate-specific antigen test for prostate cancer. As an alternative, MedPAC might consider charging beneficiaries more for low value services. MedPAC leaders say the cost of these procedures “subtract from the availability of public resources for high-value services and ‘appropriate subsidies’ for low-income people.”

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CMS Delays Enforcement Of “Two Midnights” Rule

CMS is delaying enforcement of the “two midnight” payment policy for short hospital stays until the end of April. The delay allows Congress time to pass the package repealing Medicare’s sustainable growth-rate formula when it reconvenes on April 13. The legislation includes a six-month delay in enforcement of the payment rule. The “two midnight” rule assumes an admission was appropriate if a patient’s stay spanned two midnights and that outpatient observation status was appropriate if it did not.

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Tiptastic Tuesday: How To Spot Signs Of Elder Abuse

According to The Elder Justice Roadmap, a report by the U.S. Department of Justice and the Department of Health and Human Services, five million Americans are affected by elder abuse every year. Abuse of the elderly can be difficult to pinpoint as its signs could appear to be symptoms of dementia or the natural results of frailty that come with growing older. It is important to know that elder abuse is not always physical and  includes other categories, including sexual, psychological, and financial neglect.

Be on the lookout for the following common signs that abuse may be happening:

  • Frequent arguments between the caregiver and the patient
  • Changes in a senior’s personality or behavior
  • Unexplained injuries like burns, bruises, welts, cuts or scars
  • Broken bones, dislocations and sprains
  • Failure to take medication or overdose of medication
  • A caregiver’s refusal to let you see the patient alone
  • Appearing disheveled, in torn or soiled clothing, or not being appropriately dressed for the weather
  • Appearing hungry, malnourished, disorientated or confused
  • Unexplained charges or a suspicious drain of money
  • Unexplained weight loss

If you notice something strange, it is important to notify authorities or to report it to Adult Protective Services (APS).

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House Passes SGR Reform Bill

Yesterday, a majority passed Medicare legislation that reforms the physician payment formula also known as the Sustainable Growth Rate (SGR). H.R. 2 will now go to the Senate where it is expected to pass.

The bill includes the previously reported provisions that affect home health and hospice services:

  1. The annual payment rate update (Market Basket Index) is set at 1% in 2018. This represents an estimated 1 point reduction from what would otherwise be the update
  2. A two year extension of the home health rural add-on at 3%. Under the bill, the add-on would expire with episodes beginning January 1, 2018 and later.
  3. Modification of the home health surety bond requirements setting the bond minimum at $50,000 and allowing Medicare to scale the bond value up commensurate with the volume of Medicare revenue in the home health agency.

The Medicare beneficiary changes do not include a home health copay.

The bill “would institute a permanent fix in the physician payment methodology” which is good news for Medicare providers as there have been 17 previous “patches” that were financed by cutting provider payment rates.

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