Hospitals’ New Message for Patients: Stay Home

Politico / By Daniel Payne
 
Health systems are trying to move more of the work they do to your house.
 
Sensors that enable staff to monitor patients remotely are less intrusive than they once were, meaning more patients comply with wearing them. That enables care providers to watch over someone from afar, Jiang Li, CEO of remote care company Vivalink, said.
 
“Almost everybody’s thinking about how to make adjustments to embrace new technology,” Li said. “This trend definitely will continue — it will continue on a global scale, not just the U.S.”
 
Most providers have increased their spending on technology in recent years, including an emphasis on telehealth and remote care, according to a 2023 report.
Health regulators are taking note — and engaging in the conversation.
 
Dr. Meena Seshamani, deputy administrator and director of the Centers for Medicare and Medicaid Services, said in a statement that the agency “continually assesses opportunities” to better the speed and reliability of care, including via technology. That assessment includes discussions “with the medical community and patient advocates on an ongoing basis.”
 
Some large hospitals are essentially opening tech consulting operations, selling the systems they’ve built in-house, or their staff’s expertise.
 
“You’re finding more health systems say: ‘What else could we do that is not necessarily wildly profitable but that just covers its own costs plus a little bit so that we can turn around and do other things?’” said Niyum Gandhi, chief financial officer and treasurer at Mass General Brigham.
 
Mass General, a major Boston hospital system, has done just that. It created an artificial intelligence business, relying on tech industry players, from GE HealthCare to Nvidia, to validate its tools. The health system, like other large health providers, is building its own AI products too, with some seeing opportunities to license them to peers.
 
That’s not a business plan just anyone can pursue.
 
In underserved areas, care options are shrinking. Rural hospitals have cut services that they see as unsustainable, even if they’re important to patients in the area.
 
Congress, in an effort to preserve care in rural areas, created a new Medicare payment designation for rural hospitals that would allow facilities to eliminate inpatient services to keep emergency rooms open.
 
And some doctors, in both small and large systems, are skeptical that technology is a panacea. Even where state-of-the-art tech is available, they worry they won’t be able to examine patients as thoroughly — or at all — when care is remote. Investigations into the use of remote monitoring sometimes suggested it led to substandard care.
 
But for patients looking for the convenience of the remote care they got during the pandemic — or hospitals who see remote care as a path to financial stability and better care — the future is coming.
 
“Things are going in the right direction,” Couris said.

Lymphedema Compression Treatment Items: New DMEPOS Benefit Category

Starting January 1, 2024, Medicare pays for lymphedema compression treatment items for Medicare Part B patients. CMS updated the following manuals with information on this new DMEPOS benefit category:

• Medicare Benefit Policy Manual, Chapter 15 (PDF):
• Section 110.8: DMEPOS benefit category determinations
• Section 145: covered items, replacements, and frequency limitations
• Instruction to your Medicare Administrative Contractor (PDF)
• Medicare Claims Processing Manual, Chapter 20 (PDF): 
• Section 181.1: payment policy
• Instruction to your Medicare Administrative Contractor (PDF)

Debbie Stabenow, Susan Collins Advocate Against Home Health Payment Cuts In Letter To CMS

Home Health Care News / By Andrew Donlan  

Sens. Debbie Stabenow (D-Mich.) and Susan Collins (R-Maine) recently sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, urging her and the agency to avoid cuts to home health payment as it nears time to release a proposed rule for 2025. 

“We appreciate CMS’ commitment to helping people get the care they need, where they need it.

This must include home health services for people with Medicare,” the senators wrote. “As CMS proceeds to develop Medicare home health payment rates for 2025, we urge you to consider the value home health care provides to the Medicare program and its beneficiaries.”

Generally, the home health payment rule proposal comes out sometime in June, with the final rule coming out at some point in late October or early November.

Since the implementation of the Patient-Driven Groupings Model (PDGM) in 2020, home health providers have seen steep and permanent cuts to payment. For instance, over the last two years, providers have seen cuts of 2.890% and -3.925% materialize.

“We are concerned that CMS recently finalized home health payment methodology that has led to steep cuts, essentially canceling out market basket updates intended to help Medicare payments keep up with inflation,” the senators continued. “Under this methodology, Medicare home health payment rates have been stagnant over the past three years, and CMS has indicated that further cuts are planned.”

The Partnership for Quality Home Healthcare (PQHH) released a data brief to illustrate how severe the cuts’ impact would be over the next five years – if not mitigated – in late April.

On Friday, PQHH commended Stabenow and Collins for taking action.

“Senators Stabenow and Collins are true champions for Medicare home health, and we applaud their continued leadership to protect the Medicare benefit and access to home-based healthcare for older Americans,” PQHH CEO Joanne Cunningham said in a statement. “We urge CMS to listen to the Senators’ advice to ensure beneficiary access to home health is prioritized in their rulemaking.”

Medicare Go-Broke Date Extended to 2036, but Warning Bells Continue Ringing

Healthcare Dive / By Pifer

The Medicare trustees’ new projection for insolvency is five years later than previous forecasts, but budget hawks warned action is still needed to shore up the insurance program’s finances.

Dive Brief:

• A key trust fund underpinning the massive Medicare program has a new insolvency date: 2036, according to a new report from the Medicare trustees.
• That’s five years later than the go-broke date in last year’s report, thanks to more workers being paid higher wages causing more revenue to flow into the trust fund’s coffers, along with lower spending on pricey hospital and home health services.
• Still, looming insolvency absent action in Washington remains a serious source of concern for the longevity of Medicare, which covers almost 67 million senior and disabled Americans, according to budget hawks.

Dive Insight:
 
Dire predictions in the annual Medicare trustees report have varied in the past few years. In 2020, in the early throes of COVID-19, the board predicted the Hospital Insurance Trust Fund fund would run out by 2026. That deadline was pushed back to 2028 and then 2031 in subsequent years’ reports, amid a broader economic rebound and more care shifting to cheaper outpatient settings.
 
Now, the trustees — a group comprised of the Treasury, Labor and HHS secretaries, along with the Social Security commissioner — are forecasting an additional five years of breathing room for Medicare solvency.
 
Along with the healthier economy, that’s in part due to the Inflation Reduction Act passed in 2022, which restrains price growth and allows Medicare to negotiate drug prices for certain Part B and Part D drugs, and should lower government spending in the program overall, according to the report.
 
The Hospital Insurance Trust Fund, which pays hospitals and providers of post-acute services, and also covers some of the cost of private Medicare Advantage plans, is mostly funded by payroll taxes, along with income from premiums.

The HI fund is separate from another trust fund that covers benefits for Medicare Parts B and D, including outpatient services and physician-administered drugs. That Supplemental Medical Insurance trust fund is largely funded by premiums and general revenue that resets each year and doesn’t face the same solvency concerns.
 
In 2023, HI income exceeded spending by $12.2 billion. Surpluses should continue through 2029, followed by deficits until the fund runs out entirely in 2036, according to the report.
At that point, the government won’t be able to pay full benefits for inpatient hospital visits, nursing home stays and home healthcare.
 
Spending is projected to grow substantially in Medicare largely due to demographic changes…

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