/ en Wed, 30 Jul 2025 08:29:09 -0500 Fri, 25 Jul 25 13:17:50 -0500 /news/headline/2025-07-25-63-million-americans-are-family-caregivers <p>A <a href="https://press.aarp.org/2025-07-24-New-Report-Reveals-Crisis-Point-for-Americas-63-million-Family-Caregivers" title="family care report">report</a> from AARP and the National Alliance for Caregiving released today found nearly 1 in 4 U.S. adults (63 million) are caring for an adult or child with a complex medical condition or disability. Over half of the caretakers are managing complex medical and nursing tasks like injections, wound care or medication management, though only 20% have training to do so. </p> Fri, 25 Jul 2025 13:17:50 -0500 Home Health /advisory/2025-07-18-home-health-prospective-payment-system-proposed-rule-cy-2026 <div class="container"><div class="row"><div class="col-md-8"><p>The Centers for Medicare & Medicaid Services (CMS) June 30 issued its <a href="https://www.federalregister.gov/documents/2025/07/02/2025-12347/medicare-and-medicaid-programs-calendar-year-2026-home-health-prospective-payment-system-hh-pps-rate" target="_blank">proposed rule</a> for the calendar year (CY) 2026 home health (HH) prospective payment system (PPS). Comments are due Sept. 2, and a final rule is expected around Nov. 1. New policies would generally be effective Jan. 1, 2026.</p><div><h2>Key Highlights</h2><p>The proposed rule would:</p><ul><li>Reduce net HH payments by an estimated 6.4%, or $1.135 billion, compared to CY 2025 payments. This reduction includes:<ul><li>A 3.2% market basket update, reduced by a 0.8% productivity adjustment.</li><li>A permanent behavioral adjustment (applied to the 30-day episode payment rate only) that is expected to reduce payments by 3.7%.</li><li>A temporary behavioral adjustment (applied to the 30-day episode payment rate only) that is expected to reduce payments by 4.6%.</li><li>An estimated 0.5% decrease in payments due to changes in outlier payments.</li></ul></li><li>Allow the face-to-face visit to be performed by any physician or non-physician practitioner, regardless of which practitioner certifies the need for HH services.</li><li>Remove a measure on patient COVID-19 vaccination and four patient assessment data elements related to social drivers of health.</li><li>Adopt a revised HH Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and related measures.</li><li>Adopt one claims-based and three Outcome and Assessment Information Set (OASIS) based measures to the HH value-based payment (VBP) program.</li><li>Make several updates to the Medicare provider enrollment and accreditation regulations for durable medical equipment providers and suppliers.</li></ul></div><h2>AHA Take</h2><p>The AHA is concerned with CMS’ substantial proposed cuts to the HH PPS. Hospitals and other providers rely on both hospital-based and freestanding HH agencies to care for patients following discharge. Reimbursement cuts of this magnitude would reduce capacity and place a burden and strain back on hospitals, as well as patients who may be unable to access safe, effective and appropriate post-hospital care. The AHA will urge CMS to reconsider its approach to these payment reductions to ensure access for those in need of continued recovery at home.</p><h2>What You Can Do</h2><ul><li>Share this advisory with your senior management team to examine the impact these payment changes would have on your organization in CY 2026.</li><li>Submit a comment letter on the proposed rule to CMS by Sept. 2 explaining the rule’s impact on your patients, staff, facility and local health care partners.</li></ul><h2>Proposed CY 2026 Payment Updates</h2><p>The rule proposes a decrease in payments of 6.4%, or $1.135 billion, in CY 2026 as compared to CY 2025. This includes a proposed market basket update of 3.2%, reduced by a statutorily required 0.8% productivity factor. Further, CMS proposes a cut of 4.059% as a permanent behavioral adjustment (discussed further below); this would reduce payments by 3.7% overall, or $655 million. The agency also proposes a cut of 5.0% as a temporary adjustment (also discussed further below); this would reduce payments by 4.6% or $815 million. In addition, CMS estimates there would be a 0.5% decrease in payments because of an updated fixed-dollar loss ratio for outlier payments.</p><p>CMS also provides an estimate of impact by type of HH agency. It estimates that freestanding HH agencies would see a 6.3% decrease in payments, and facility-based HH agencies would receive a 5.7% decrease. In addition, HH agencies located in rural areas would receive a 6.1% decrease, while those in urban areas would see a 6.5% decrease.</p><h3>Proposed 30-day Episode Rates</h3><p>Applying the net market basket increase, behavioral adjustments, as well as budget neutrality factors for updated case-mix weights and wage indexes, CMS proposes an updated 30-day payment amount of $1,933.61. This is the standardized amount that is multiplied by case-mix weight and other factors to determine the final payment. This amount is 6.4% lower than the current 30-day payment rate of $2,057.35. Table 26 in the proposed rule (copied below) provides a breakdown of these changes. These proposed factors are subject to change due to updated data that become available prior to the publication of the final rule. Providers who fail to submit quality data would receive a 2-percentage-point reduction in their 30-day payment rate.</p><img src="/sites/default/files/inline-images/Table-26-CY-2026-National-Standardized-30-Day-Period-Payment-Amount.jpg" data-entity-uuid="97af0294-541a-486d-a76b-a8e841fdfc00" data-entity-type="file" alt="Table 26: CY 2026 National, Standardized 30-Day Period Payment Amount" width="854" height="258" class="align-center"><h3>Proposed Low Utilization Payment Adjustment (LUPA) Threshold and Rates</h3><p>Under the Patient-driven Groupings Model (PDGM), claims that do not meet a certain threshold of total visits are paid under the LUPA methodology, which is a per-visit rate. The LUPA methodology sets a visit threshold for each payment group at the 10th percentile of visits or two visits, whichever is higher. If the LUPA threshold is met, the case is paid the full 30-day period payment; if not, the LUPA per-visit rates apply. The proposed rule would update the LUPA thresholds using CY 2024 HH claims. These thresholds are listed in Table 25 of the proposed rule, which also includes the proposed recalibrated weights and other factors for payment groups.</p><p>CMS also updates the per-visit payment amount for each visit type using the payment update factors. As mentioned previously, the behavioral adjustments do not apply to these rates and only apply to the 30-day episode payment rate. Below are the proposed updated LUPA visit amounts from Table 28 of the proposed rule. Agencies that do not submit required quality data would have LUPA payments reduced by 2 percentage points.</p><img src="/sites/default/files/inline-images/Table-28-CY-2026-National-Per-Visit-Payment-Amounts.jpg" data-entity-uuid="a51f90ad-4cf7-4d3b-8d08-2b42ccbe6389" data-entity-type="file" alt="Table 28: CY 2026 National Per-Visit Payment Amounts" width="870" height="255" class="align-center"><h3>Case-mix Weights</h3><p>PDGM categorizes patients into one of 432 payment units, known as HH resource groups, using patient assessment data collected with the OASIS tool and other data. CMS annually recalibrates the HH case-mix weights based on the most recent, complete year of claims and patient assessment data. To recalibrate the CY 2026 weights, CMS proposes to use CY 2024 data to weight 30-day episodes under PDGM. This is the same methodology CMS used for CY 2025. The proposed 2026 case-mix weights are provided in Table 25 in the proposed rule and are available for download from CMS’ <a href="https://www.cms.gov/medicare/payment/prospective-payment-systems/home-health/home-health-prospective-payment-system-regulations-and-notices/cms-1828-p" target="_blank">HH PPS webpage</a>. These proposed weights are subject to change due to updated data that becomes available prior to the publication of the final rule.</p><p>CMS also applies a budget neutrality factor to the 30-day payment rate to ensure that case-mix weight changes do not increase or decrease overall payments. This year, CMS is proposing a budget neutrality factor of 1.0051, or 0.51% to account for proposed case-mix weight changes.</p><h3>Functional Impairment Levels</h3><p>Under PDGM, the functional impairment-related case-mix adjustment is determined by responses to certain OASIS items associated with activities of daily living and risk of hospitalization. A HH period of care receives points based on responses from these functional OASIS items. The sum of all these points is used to group HH periods into low, medium and high functional impairment levels, designed so that about one-third of HH periods fall within each level. For CY 2026, CMS proposes to use the CY 2024 claims data to update the functional points and functional impairment levels by clinical group and the same methodology used for CY 2025. The proposed OASIS functional points and the functional impairment thresholds by clinical group for CY 2026 are listed in the rule’s Tables 20 and 21, respectively.</p><h3>Comorbidity Groups</h3><p>Thirty-day episodes of care receive a comorbidity adjustment based on the presence of certain secondary diagnoses reported on HH claims. These diagnoses are based on a list of clinically and statistically significant secondary diagnoses subgroups with similar resource use. A “low-comorbidity adjustment” would be applied if one secondary diagnosis is present that is associated with higher resource use, and a “high-comorbidity” adjustment would be applied if two or more qualifying secondary diagnoses are present. For CY 2026, CMS proposes to continue using the same methodology, in combination with CY 2024 data. This would result in 20 low-comorbidity adjustment subgroups and 100 high-comorbidity adjustment subgroups. These subgroups are listed in Tables 22 and 23 of the proposed rule.</p><h3>High-cost Outliers</h3><p>HH PPS outlier payments are applied to 30-day episodes with estimated costs that exceed the outlier threshold, which is the sum of the payment amount and a wage-adjusted fixed-dollar loss (FDL) amount. The FDL amount is calculated by multiplying the FDL ratio by the payment amount for that claim. The payment made to providers for qualifying outlier claims is a percentage (referred to as the loss-sharing ratio) of the costs that surpass the threshold. For the HH PPS, the statute requires that the FDL amount and the loss-sharing ratio be set to target total outlier payments at 2.5% of aggregate payments. For CY 2026, CMS proposes no change to the existing 0.80 (80%) loss-sharing ratio. However, it proposes to increase the FDL ratio from 0.35 to 0.46, which it says would decrease overall payments by 0.5%, or $90 million, relative to CY 2025.</p><h2>Proposed Behavioral Adjustments Related to PDGM Implementation</h2><p>In 2018, Congress mandated that CMS implement the PDGM, which transitioned on Jan. 1, 2020, the HH PPS from a 60-day payment episode to a 30-day payment episode. The PDGM case-mix system bases payments on the clinical characteristics of a patient, abandoning the prior methodology of relying on therapy volume to determine payment. The clinical characteristics used to determine payment amounts include admission source and timing, principal diagnosis, functional impairment level and comorbidities. Under the PDGM, each 30-day episode is assigned to one of 432 HH resource groups.</p><p>CMS was required to set the initial PDGM 30-day episode payment amount at a budget-neutral level. To accomplish budget neutrality, CMS made several assumptions regarding providers’ expected behavioral changes. Specifically, CMS assumed that HH agencies would alter their coding of primary and secondary diagnoses on which payments are based. In addition, CMS assumed that the number of LUPA cases would decrease. After estimating the impact of these assumed behavioral changes, CMS finalized a behavioral offset of 4.36% to the 30-day payment rate in the CY 2020 final rule.</p><p>Congress also required that CMS maintain budget neutrality relative to the former payment system through CY 2026. The agency says it must apply two types of adjustments to maintain budget neutrality. The first is permanent adjustments to the 30-day payment rate to ensure that <em>future</em> spending neither increases nor decreases relative to what would have been paid. The second is temporary adjustments to recoup or repay <em>past</em> over- or underspending. Accordingly, the agency calculated and applied additional <em>permanent</em> budget neutrality adjustments in CYs 2023, 2024 and 2025 once data became available for payments post-implementation of the PDGM. CMS did not apply any <em>temporary</em> adjustments in these years, but it did provide estimates of the expected temporary recoupments needed to meet its statutory obligations for these years.</p><p>In the CY 2023 final rule, CMS determined that 30-day payments in CYs 2020 and 2021 were approximately 7.85% higher than they would have been under the legacy payment model. Therefore, it would need to prospectively reduce the 30-day payment rate permanently to ensure budget neutrality. However, for CY 2023, CMS only applied half of the needed permanent adjustment (-3.925%) and said it would apply the remainder in future years. For CY 2024, CMS determined that an additional adjustment of 5.78% was necessary to ensure budget neutrality based on claims through CY 2022. However, in response to concerns from providers, CMS decided to implement only half of this amount again, or -2.89%. In the CY 2025 rulemaking, CMS found that a -3.95% cut was necessary to achieve budget neutrality based upon claims through CY 2023. Again, CMS only implemented half that amount, or -1.975% in CY 2025.</p><p>CMS has now determined that, based upon claims analysis through CY 2024 claims, the 30-day payment rate is 4.059% higher than it would have been had CMS maintained budget neutrality. This includes both prior years’ adjustments that were not fully implemented and newly calculated adjustments based upon a review of CY 2024 claims. Therefore, CMS is proposing to implement the full permanent adjustment of -4.059% to the 30-day payment rate for CY 2026. CMS says this would reduce payments by approximately $655 million. The table below from the proposed rule shows both the overpayments calculated by CMS as well as the permanent adjustments that have been or are proposed to be implemented to date.</p><img src="/sites/default/files/inline-images/Table-18-Summary-of-Permanent-Adjustments-for-CYs-2020-2026.jpg" data-entity-uuid="8e2f44a4-a53f-4adc-af4b-1261ee35e293" data-entity-type="file" alt="Table 18: Summary of Permanent Adjustments for CYs 2020-2026" width="936" height="447" class="align-center"><p>As mentioned, in addition to permanent adjustments to prospectively ensure budget neutrality, CMS also says it is obligated to apply temporary adjustments to the 30-day payment rate to recoup past overpayments. Prior to this rulemaking, CMS had not yet proposed any of these temporary adjustments, although it did provide estimates for amounts needed to be recouped. In this rulemaking, CMS is proposing to begin implementing temporary adjustments to recoup what it says were overpayments from CY 2020 through CY 2024. To date, CMS says overpayments have totaled $5.3 billion. To recoup this all in CY 2026, CMS says it would need to apply an approximately 34% reduction to the 30-day payment rate. However, it also says that such a big reduction would place a hardship on providers, and instead proposes to implement a 5% temporary reduction to the base payment rate for CY 2026 to begin recouping overpayments. CMS says this would result in recouping about 14.8% of the overpayments to date in CY 2026, or approximately $786 million. Table 19 from the proposed rule below shows the overpayments CMS says must be recouped by CY.</p><img src="/sites/default/files/inline-images/Table-19-Summary-of-Temporary-Adjustments-Dollar-Amounts-for-CYs-2020-2026.jpg" data-entity-uuid="ead53bfe-f6d5-4498-86d2-7e71cd12ca8a" data-entity-type="file" alt="Table 19: Summary of Temporary Adjustments Dollar Amounts for CYs 2020-2026" width="936" height="490" class="align-center"><p>The permanent and temporary adjustments apply to the 30-day payment rate. They do not apply to other payments, such as LUPAs. Therefore, the permanent adjustment of -4.059% would reduce total payments by approximately 3.7%, and the temporary adjustment of 5.0% would reduce overall payments by approximately 4.6%. In addition, the temporary adjustment would not be factored in when determining future rates, so CMS would base its updated 30-day payment rates in future rulemakings on rates without the 5.0% reduction included. Finally, CMS says that all CY 2024 claims data was not available at the time of the proposed rule. Therefore, as it has done in prior rulemakings, it would update its proposed behavioral adjustments in the final rule using updated data.</p><h2>Proposed Change to Face-to-Face Encounter Requirement</h2><p>A HH beneficiary is required to have a face-to-face visit with either a physician or a non-physician practitioner (NPP). Currently, if the visit is performed by a physician, it must be the physician who also provides the certification for the need for home health services.<a href="#fn1"><sup>1</sup></a> However, if the visit is performed by an NPP, a different physician or NPP may certify the need for home health services. However, to provide additional flexibility and simplification, CMS is proposing to allow the visit to be performed by any physician or NPP regardless of which practitioner certifies the need for home health services. In this proposal, CMS also clarifies that the face-to-face visit documentation must still be related to the primary reason the patient requires home health services.</p><h2>HH Quality Reporting Program</h2><p>As mandated by the Social Security Act, HH agencies receiving Medicare payments have been required to collect and submit patient assessment data using the OASIS since 1999 and to participate in the HH Quality Reporting Program (QRP) since 2007. The Improving Medicare Post-Acute Care Transformation (IMPACT) Act required that, starting CY 2020, providers must report standardized patient assessment data elements (SPADEs) as part of the HH QRP. Failure to comply with these requirements results in a 2-percentage-point reduction to the HH agency’s annual market-basket update. In this rule, CMS proposes to remove one quality measure and four SPADEs beginning with the CY 2026 HH QRP. For FY 2025, the HH QRP comprises 19 measures (as the HHCAHPS Survey is reported as a single measure informed by multiple sub-items) based on updates to the QRP in previous rulemaking.</p><h3>Table 1: Previously Finalized Measures for the HH QRP, CY 2024-CY 2026</h3><table><thead><tr><th>Data Source</th><th>Measure</th><th>CY 25</th><th>CY 26</th><th>CY 27</th></tr></thead><tbody><tr><td rowspan="18">OASIS</td><td>Application of Percent of residents experiencing one or more falls with major injury (Long stay)</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Discharge Function Score</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Percent of Patients/Residents who are Up to Date with COVID-19 Vaccination</td><td>X</td><td>Y</td><td>Y</td></tr><tr><td>Improvement in Ambulation/Locomotion</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Improvement in Bathing</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Improvement in Bed Transferring</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Improvement in Dyspnea</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Influenza Immunization Received for Current Flu Season</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Improvement in Management of Oral Medications</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Timely Initiation of Care</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Drug regimen review conducted with follow-up for identified issues</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Transfer of Health Information to Provider</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Transfer of Health Information to Patient</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Total Estimated Medicare Spending per Beneficiary (MSPB)</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Potentially Preventable 30-day Post-Discharge Readmissions</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Home Health Within Stay Potentially Preventable Hospitalization</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Discharge to Community</td><td>X</td><td>X</td><td>X</td></tr><tr><td rowspan="5">HHCAHPS Survey</td><td>Care of Patients</td><td>X</td><td>X</td><td>Y</td></tr><tr><td>Communications between Providers and Patients</td><td>X</td><td>X</td><td>Y</td></tr><tr><td>Specific Care Issues</td><td>X</td><td>X</td><td>Y</td></tr><tr><td>Overall Rating</td><td>X</td><td>X</td><td>Y</td></tr><tr><td>Willingness to Recommend</td><td>X</td><td>X</td><td>Y</td></tr></tbody></table><p>X=Measure required for reporting as previously finalized</p><p>Y=Measure proposed for removal or modification in this rule</p><hr><h3>Proposed Removal of COVID-19 Vaccine: Percent of Patients Who Are Up-to-Date Measure</h3><p>CMS proposes to remove this measure from the HH QRP beginning with the CY 2026 program. The measure was originally adopted in the CY 2024 HH PPS final rule. Citing declining numbers of COVID-19 cases and deaths as well as the continued costs and burden to providers of reporting this measure, CMS estimates that cost savings from the measure’s removal as 47,168 hours annually across 11,904 HH agencies — a total of $4,326,249.</p><p>CMS proposes that, if finalized, data from the OASIS item O0350 would no longer be used to calculate the measure effective with the publication of the final CY 2026 HH PPS rule; the agency would formally remove the measure and associated OASIS beginning April 1, 2026. This means that, upon finalization of the proposal later this year and until the item can be removed from OASIS, HH agencies could enter any response (0, 1 or a dash) for the item with no effect on measure calculation (uncompleted responses would not meet submission requirements).</p><h3>Proposed Removal of Four Recently Adopted SPADEs</h3><p>Beginning with patients discharged on or after April 1, 2026, CMS proposes to remove four SPADEs under the social determinants of health category from all post-acute care patient assessment tools, including OASIS. CMS cites the “undue burden” that the collection of this information places upon providers and estimates that removing the items will save 158,835 hours of labor across all 11,904 HH agencies and $13,484,033 annually (or $1,132 per HH agency).</p><p>These items were finalized for adoption in the CY 2025 HH PPS final rule and slated to begin reporting with patients discharged in CY 2027; they include:</p><ul><li>Living Situation (R0310): What is your living situation today?</li><li>Food (R0320A): Within the past 12 months, you worried that your food would run out before you got money to buy more.</li><li>Food (R0320B): Within the past 12 months, the food you bought just didn’t last, and you didn’t have money to get more.</li></ul><p>Utilities (R0330): In the past 12 months, has the electric, gas, oil, or water company threatened to shut off services in your home?</p><h3>Proposed Revisions to HHCAHPS Survey and Measures</h3><p>CMS proposes to implement a revised (and shortened) version of the HHCAHPS survey and accompanying measures beginning with the April 2026 sample month.</p><p>The revisions were made based on an experiment that CMS conducted with 100 HH agencies in 2022 and include the addition of three new questions (which CMS calls “items”) to assess new topics of importance to patients and the removal of several questions on topics of less importance or not currently used in public reporting composites. CMS also made minor text changes to selected existing questions to help clarify the question or response options. The revised survey and measures were reviewed as part of the 2025 Pre-Rulemaking Measure Review process and recommended for adoption by the Post-Acute Care/Long-Term Care Committee. The table below provides a summary of the proposed changes, and Table 31 in the CY 2026 HH PPS proposed rule provides a comprehensive comparison of the current and proposed survey items.</p><h3>Table 2. Summary of Proposed HHCAHPS Measure Revisions</h3><table><thead><tr><th>Current Measures (Number of Items)</th><th>Proposed Measures (Number of Items)</th></tr></thead><tbody><tr><td>Care of Patients (4 items)</td><td>Care of Patients (5 items)</td></tr><tr><td>Communications between Providers and Patients (6 items)</td><td>Communications between Providers and Patients (5 items)</td></tr><tr><td rowspan="3">Specific Care Issues (7 items)</td><td>Talk About Home Safety (standalone item)</td></tr><tr><td>Review Medicines (standalone item)</td></tr><tr><td>Talk About Medicine Side Effects (standalone item)</td></tr><tr><td>Overall Rating (1 item)</td><td>Overall Rating (1 item)</td></tr><tr><td>Willingness to Recommend (1 item)</td><td>Willingness to Recommend (1 item)</td></tr><tr><td><strong>Total: 19 items</strong></td><td><strong>Total: 15 items</strong></td></tr></tbody></table><hr><p>If the revised survey and associated measures are finalized for adoption as proposed, CMS would adjust the methodology for the Summary Star Rating to account for these updates. Specifically, the Summary Rating would be based on the Overall Rating of Care; the new composite Care of Patients and Communications between Providers and Patients measures at a weight of one each; and the three new standalone measures at a weight of 1/3 each. The rest of the scoring methodology and public reporting policy would not change. Because the Summary Star Rating is calculated using four rolling quarters of data, scores on the new measures would not be publicly reported until October 2027 (based on data from the second quarter of 2026 through the first quarter of 2027); providers would be able to view their interim scores on their confidential Provider Preview reports after two full quarters of data are submitted.</p><p>CMS also proposes one change to the case-mix adjustment to survey scores. These adjustments refer to characteristics of the patient that are not under control of the HH agency that may affect reports of experience and include patient age, patient education, self-reported overall health, self-reported mental health, diagnosis of schizophrenia or dementia, whether the patient lives alone, whether the patient or a proxy answered the survey, and the language in which the survey was completed. Based on the same 2022 experiment, CMS found that the diagnosis adjustments were no longer significant and thus proposes to drop this adjustment from the scoring methodology.</p><p>Also based on findings from the 2022 experiment, CMS proposes to add a mode adjustment to the scoring methodology to account for differences in overall rating by telephone-only respondents. The agency notes that this is because telephone-only respondents were more negative in their evaluations of care relative to mail-only respondents across all measures, but the adjustments were generally small (most around 2 percentage points).</p><h3>Proposed Updates to Reconsideration Process</h3><p>Most CMS quality reporting and value programs — including the HH QRP — include a reconsideration process permitting providers to appeal a CMS initial determination of noncompliance with reporting or other programmatic requirements. In this rule, CMS proposes to specify the deadline for an HH agency to request an extension for a reconsideration request as 30 days from the date of the written notice of noncompliance. In addition, the agency proposes to grant requests for reconsiderations and reverse initial findings of noncompliance if the agency determines that the HH agency was in full compliance with the QRP requirements for the applicable program year, including established policies for extraordinary circumstances exceptions.</p><h3>Regulatory Text Updates to Account for All-Payer OASIS Data Reporting</h3><p>As finalized in the CY 2023 HH PPS final rule, CMS will require HH agencies to submit all-payer OASIS data for purposes of the HH QRP, beginning with voluntary data submission between Jan. 1, 2025, and June 30, 2025, and mandatory data submission beginning July 1, 2025, for the CY 2027 program year. In this proposed rule, CMS proposes updates to the regulatory text to reflect this previously finalized change. Specifically, CMS would change language in the HH Conditions of Participation regarding transmission of OASIS assessments to refer to “patients” instead of “beneficiaries,” as assessment data must now be submitted for all patients, including those who are not beneficiaries of Medicare or Medicaid. This does not change any other policy for assessment data reporting, including any exemptions for the OASIS.</p><h3>Request for Information (RFI): Shortening Data Submission Timelines</h3><p>CMS seeks input on decreasing the amount of time that HH agencies must submit quarterly quality measures and SPADE data to CMS. The agency notes that it is concerned that the time between data collection and measure reporting is too long, at nine months. The agency believes that the primary driver of this lag is the four and a half months after a quarter closes that HH agencies must submit data to CMS. CMS seeks input on potentially requiring that quality and SPADE data be submitted 45 days after the close of a quarter instead. The agency believes this would result in more timely publicly-reported data on HH agency performance. CMS found that, in 2022, only 1.3% of all OASIS assessments were submitted after 60 days, and only 0.9% were submitted between 60 days and the 4.5-month deadline.</p><h3>RFI: Digital Quality Measurement</h3><p>CMS seeks input on how to advance the uptake of digital quality measures in the HH QRP. CMS is particularly interested in the extent to which HH agencies are using application programming interfaces based on the Fast Healthcare Interoperability Resource standard to support any data reporting or exchange functions.</p><h3>RFI: Measure Concepts Under Consideration for Future Years</h3><p>CMS seeks public comment on the importance, relevance, appropriateness and applicability of certain quality measure concepts for future use in the HH QRP. These concepts include:</p><ul><li>Interoperability.</li><li>Cognitive function.</li><li>Nutrition.</li><li>Patient well-being.</li></ul><h2>HH Value-Based Purchasing Program</h2><p>The HH VBP model was adopted as a demonstration in the CY 2016 HH PPS final rule. In the CY 2022 HH PPS final rule, CMS finalized the expansion of the model nationwide beginning Jan. 1, 2022; read about the program methodology in AHA’s <a href="/advisory/2021-11-22-home-health-pps-final-cy-2022-rule">Regulatory Advisory</a> on that rule. In this proposed rule, CMS proposes to adopt one claims-based measure and three OASIS-based measures into the program’s measure set and to adjust the measure set and scoring based on changes proposed herein. The agency reasons that adopting more measures will increase the number of HH agencies that meet minimum HH VBP payment adjustment requirements.</p><h3>Proposed Adoption of Medicare Spending Per Beneficiary Post-Acute Care (MSPB-PAC) Measure</h3><p>CMS proposes to add this claims-based measure to the HHVBP measure set starting in CY 2026. MSPB-PAC assesses Medicare spending for Part A and B services clinically related to HH services during an episode of care relative to the Medicare spending for other HH agencies and is based on two years of data. The measure was added to the HH QRP in 2017 and is used across all post-acute care settings; if finalized as proposed, CMS would likely report scoring thresholds for this measure in the HH VBP program in the October 2025 Interim Performance Reports.</p><h3>Proposed Adoption of OASIS-based Function Measures</h3><p>CMS proposes to add three measures informed by OASIS assessment data to the HH VBP measure set starting in CY 2026. They include Improvement in Bathing (M1830), Improvement in Upper Body Dressing (M1810), and Improvement in Lower Body Dressing (M1820). The Improvement in Bathing measure is used in the HH QRP. CMS explains that it decided against including in the HH VBP measure set the Discharge Function Score measure that was recently adopted into all four post-acute care QRPs, as that measure does not consider bathing and dressing abilities critically important for HH AGENCY patients specifically.</p><h3>Proposed Removal of Three HHCAHPS Survey-based Measures</h3><p>Elsewhere in this proposed rule, CMS proposes to revise the HHCAHPS Survey and associated measures, which would influence the inclusion of these measures in the HH VBP program. Given these changes, CMS proposes to remove the three revised HHCAHPS items as they would not be able to be calculated according to the measure specifications as they appear in the HH VBP program. The measures include Care of Patients, Communications between Providers and Patients, and Specific Care Issues. The agency notes that it may propose to adopt new versions of these measures in future rulemaking.</p><h3>Proposed Weighting Changes</h3><p>If measures are finalized for adoption into the HH VBP measure set as proposed, CMS will need to update the weights of the individual measures and categories, as they contribute to the overall score. The table below lists the current and proposed weights across the larger-volume and smaller-volume cohorts.</p><img src="/sites/default/files/inline-images/Table-34-CY-2025-and-Proposed-Individual-Measure-Weights-and-Category-Weights-for-the-Expanded-HHVBP-Model.png" data-entity-uuid="a4d4ebc0-9ca6-4b0e-ab9f-80f87209ad5d" data-entity-type="file" alt="Table 34: CY 2025 and Proposed Individual Measure Weights and Category Weights for the Expanded HHVBP Model" width="624" height="340" class="align-center"><h3>RFI: Future Performance Measure Concepts</h3><p>CMS seeks feedback on certain performance measurement concepts used in the HH VBP. Specifically, the agency solicits comments on:</p><ul><li>Adopting measures on falls with major injury, well-being, nutrition and interoperability as considered for the HH QRP.</li><li>Calculating the HHCAHPS measure score based solely on achievement versus a benchmark rather than both achievement and improvement over the previous score.</li><li>Adding three HHCAHPS survey items to the HH VBP program from the Specific Care Issues category, which are proposed in this rule to become standalone measures.</li></ul><h2>Durable Medical Equipment, Prosthetics, Orthotics and Supplies Policies</h2><p>CMS has established processes and policies for enrollment of providers and suppliers into the Medicare program, which are designed to confirm that those seeking to bill Medicare for services and items furnished to beneficiaries meet all applicable federal and state requirements. In line with previous attempts to strengthen these processes and policies to guard against fraudulent or abusive behavior by providers and suppliers, CMS proposes several changes in this proposed rule that would update regulations for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) provider enrollment and accreditation. These include:</p><ul><li>Revocation and denial of enrollment policies.</li><li>DMEPOS accreditation and accrediting organization requirements.</li><li>Prior authorization for certain DMEPOS items.</li><li>The DMEPOS competitive bidding process.</li></ul><h2>RFI: Executive Order 14192 “Unleashing Prosperity Through Deregulation”</h2><p>On Jan. 31, 2025, President Trump issued Executive Order (EO) 14192, "Unleashing Prosperity Through Deregulation," which states the administration’s policy to significantly reduce the private expenditures required to comply with federal regulations. Accordingly, CMS is soliciting public input on approaches and opportunities to streamline regulations and reduce administrative burdens on providers, suppliers, beneficiaries and other interested parties participating in the Medicare program. CMS is collecting responses at <a href="https://www.cms.gov/medicare-regulatory-relief-rfi" target="_blank">https://www.cms.gov/medicare-regulatory-relief-rfi</a> and requests stakeholders submit comments through the provided web link.</p><h2>Next Steps</h2><p>The AHA urges all HH agencies to submit comments to CMS by Sept. 2. Comments may be submitted electronically at <a href="http://www.regulations.gov/" target="_blank">www.regulations.gov</a>.</p><h2>Further Questions</h2><p>For questions about payment provisions, contact Jonathan Gold, AHA’s senior associate director of payment policy, at <a href="mailto:jgold@aha.org">jgold@aha.org</a>; for quality-related questions, contact Caitlin Gillooley, AHA’s director of policy, at <a href="mailto:cgillooley@aha.org">cgillooley@aha.org</a>.</p><hr><ol><li id="fn1">The regulations also permit the visit to have been performed by a physician other than the certifying physician if the physician performing the visit cared for the patient in an acute or post-acute facility from which the patient was directly admitted to home health.</li></ol></div><div class="col-md-4"><a href="/system/files/media/file/2025/07/Regulatory-Advisory-Home-Health-Prospective-Payment-System-Proposed-Rule-for-CY-2026.pdf" target="_blank" title="Click here to download the Regulatory Advisory: Home Health Prospective Payment System Proposed Rule for CY 2026 PDF."><img src="/sites/default/files/inline-images/Page-1-Regulatory-Advisory-Home-Health-Prospective-Payment-System-Proposed-Rule-for-CY-2026.png" data-entity-uuid="641e1533-3576-451a-b608-e88a7450fddc" data-entity-type="file" alt="Regulatory Advisory: Home Health Prospective Payment System Proposed Rule for CY 2026 page 1." width="695" height="900"></a></div></div></div> table, th, td { border: 1px solid; } tr:nth-child(even) { background-color: #b9d9eb33; } th { background-color: #002855; color: white; } Fri, 18 Jul 2025 11:40:52 -0500 Home Health /news/headline/2025-07-11-hospital-home-extension-bill-introduced <p>A bill was <a href="https://buchanan.house.gov/2025/7/buchanan-introduces-bipartisan-bicameral-legislation-to-extend-successful-hospital-at-home-programs" title="Home health bill">introduced</a> July 10 to extend certain Medicare waivers authorizing the hospital-at-home care program. The bill was introduced in the House by Reps. Vern Buchanan, R-Fla., Lloyd Smucker, R-Pa., and Dwight Evans D-Pa., and in the Senate by Sens. Tim Scott, R-S.C., and Rev. Raphael Warnock, D-Ga.</p><p>The AHA supports the Hospital Inpatient Services Modernization Act to extend the H@H waiver for five years. Without the extension, the waivers will expire Sept. 30, 2025. An AHA <a href="/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program" title="facts">fact sheet</a> explains the issue and states, “A long-term extension will not only provide additional time to continue gathering data on quality improvement, cost savings, and patient experience, but will also provide much needed stability for new programs and may ease state concerns about updating Medicaid policies to allow for coverage of these services.” </p> Fri, 11 Jul 2025 13:22:56 -0500 Home Health /news/headline/2025-06-30-cms-proposes-64-decrease-home-health-payments-cy-2026-updates-quality-and-value-based-purchasing <p>The Centers for Medicare & Medicaid Services June 30 issued its calendar year 2026 <a href="https://www.federalregister.gov/public-inspection/2025-12347/medicare-and-medicaid-programs-calendar-year-2026-home-health-prospective-payment-system-rate-update">proposed rule</a> for the home health prospective payment system. This rule would reduce HH payments by an estimated 6.4%, or $1.13 billion, in CY 2026 relative to 2025. This update includes a 3.2% market basket update, reduced by a 0.8 percentage point cut for productivity. The rule also includes several reductions that CMS proposes as necessary to achieve budget neutral implementation of the Patient-driven Groupings Model. These are a 4.1% permanent reduction to the standard payment rate to prevent future overpayments, as well as a temporary but indefinite 5.0% reduction to recoup past overpayments. CMS also proposes a 0.5% reduction related to high-cost outlier payments. These negative payment updates come on top of numerous other reductions in recent years; as such, AHA has expressed ongoing concern about the impact these cuts may have on access to care for patients, including those being discharged from hospitals. <br> <br>For the Home Health Quality Reporting Program, CMS proposes to remove the measure assessing the percentage of patients receiving COVID-19 vaccinations. The agency also would remove four standardized patient assessment data elements focused on living situation, food and utilities. The rule also includes requests for information on changing the data submission deadline for HH QRP data, advancing digital quality measures and new measure concepts for the HH QRP. CMS also proposes to add four new measures to the HH Value-Based Purchasing Model — Medicare Spending per Beneficiary, and three measures assessing patient functional improvement in dressing and bathing.  <br> <br>CMS will accept comments on the proposed rule for 60 days following publication in the Federal Register. AHA members will receive a Special Bulletin with additional details on the rule in the coming days.</p> Mon, 30 Jun 2025 17:08:15 -0500 Home Health /aha-center-health-innovation-market-scan/2024-11-19-providence-and-compassus-partner-launch-home-health-care-joint-venture <div class="container"><div class="row"><div class="col-md-8"><p><img src="/sites/default/files/inline-images/Providence-and-Compassus-Partner-to-Launch-Home-Health-Care-Joint-Venture.png" data-entity-uuid="357bd3ce-1d05-474f-8fa9-07fb33dc1a70" data-entity-type="file" alt="Providence and Compassus Partner to Launch Home Health Care Joint Venture. A home-health nurse takes an elderly man's blood pressure in his home." width="100%" height="100%"></p><p><a href="https://www.providence.org/" target="_blank" title="Providence homepage">Providence</a> health system <a href="https://blog.providence.org/national-news/providence-and-compassus-announce-joint-venture-for-home-based-care-services" target="_blank" title="Providence Blog: Providence and Compassus announce joint venture for home-based care services">announced a new joint venture</a> with home care provider <a href="https://www.compassus.com/" target="_blank" title="Compassus homepage">Compassus</a> to expand its reach in the home health market. The joint venture, “Providence at Home with Compassus,” will deliver a comprehensive range of services, including home health, hospice, community-based palliative care and private-duty caregiving.</p><p>Under the partnership, Compassus will oversee operations across 24 home health locations in Alaska, California, Oregon and Washington, along with 17 hospice and palliative care sites in Alaska, California, Oregon, Texas and Washington. According to Providence Chief Financial Officer Greg Hoffman, the initiative addresses the rising demand for home health and hospice care among aging populations. By expanding home health services, Providence aims to reduce the length of hospital stays and enhance post-acute care options, allowing for higher patient volumes in acute settings.</p><p>This expansion aligns with Providence’s efforts to improve patient-processing efficiency and bolster revenue following financial setbacks during the pandemic. Providence recently achieved operational profitability for the first half of the fiscal year, partly due to initiatives that <a href="https://www.fiercehealthcare.com/providers/halfway-through-2024-providences-operations-600m-over-last-year#:~:text=the%20prior%20year.-,These%20came%20alongside%20greater%20access%20to%20post%2Dacute%20care%20that%20fueled%20a%204%25%20decrease%20in%20length%20of%20stay%2C%20management%20said%20in%20a%20filing.,-Outside%20of%20the" target="_blank" title="Fierce Healthcare: Halfway through 2024, Providence's operations up $600M over last year">cut patient lengths of stay by 4%</a>.</p><p>The <a href="https://www.grandviewresearch.com/press-release/global-home-healthcare-market" target="_blank" title="Grand View Research: Home Healthcare Market Size To Reach $666.91 Billion By 2030">global home health market is projected to reach $666.9 billion by 2030</a>, driven by growing demand among aging populations and increased telehealth adoption.</p></div><div class="col-md-4"><p><a href="/center" title="Visit the AHA Center for Health Innovation landing page."><img src="/sites/default/files/inline-images/logo-aha-innovation-center-color-sm.jpg" data-entity-uuid="7ade6b12-de98-4d0b-965f-a7c99d9463c5" alt="AHA Center for Health Innovation logo" width="721" height="130" data-entity- type="file" class="align-center"></a></p><p><a href="/center/form/innovation-subscription"><img src="/sites/default/files/2019-04/Market_Scan_Call_Out_360x300.png" data-entity-uuid data-entity-type alt width="360" height="300"></a></p></div></div></div>.field_featured_image { position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } .featured-image{ position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } Tue, 19 Nov 2024 06:00:00 -0600 Home Health /news/headline/2024-11-01-cms-releases-cy-2025-home-health-pps-final-rule-partially-delays-behavioral-adjustments <p>The Centers for Medicare & Medicaid Services today issued its calendar year 2025 final rule for the <a href="https://www.federalregister.gov/public-inspection/2024-25441/medicare-program-calendar-year-2025-home-health-prospective-payment-system-rate-update-quality">home health prospective payment system</a>. Overall, this rule will increase HH payments by $85 million, or 0.5% compared to CY 2024. This update is the result of a 3.2% market basket update, offset by a 0.5% productivity reduction. In addition, CMS says payments will be reduced by 0.4% overall due to changes to fixed-dollar loss ratio for outlier payments. Further, CMS is applying a behavioral adjustment of -1.8% as required as part of implementation of the new Patient Driven Groupings Model. This reduction is half of the -3.6% CMS originally proposed due to concerns raised by AHA and other stakeholders about the impact further reductions will have on access to care. However, the agency states that it will apply the remainder of this permanent adjustment in future years. <br><br>For the Home Health Quality Reporting Program, CMS finalized its proposal to adopt four new standardized patient assessment data elements related to social determinants of health beginning with the CY 2027 program. In addition, the agency finalized a new Condition of Participation that sets standards for patient acceptance-to-service policies for HH agencies, as well as a new data reporting standard on respiratory illnesses for long-term care facilities beginning Jan. 1, 2025.</p> Fri, 01 Nov 2024 15:15:40 -0500 Home Health /aha-center-health-innovation-market-scan/2024-09-17-key-insights-health-cares-top-consulting-needs <div class="container"><div class="row"><div class="col-md-8"><p><img src="/sites/default/files/inline-images/Key-Insights-on-Health-Cares-Top-Consulting-Needs.png" data-entity-uuid="86a03555-3295-4aeb-b190-a6e227df3566" data-entity-type="file" alt="Key Insights on Health Care's Top Consulting Needs. A diverse group of hospital executives meet with a consultant to discuss operational improvements, expanding home health care, and cyber-risk management and cybersecurity." width="100%" height="100%"></p><p>When it comes to improving performance in their most pressing business, clinical and operations areas, health care leaders often turn to management consulting firms for analysis and guidance. A recent <a href="https://www.modernhealthcare.com/finance/management-consulting-firms-survey-takeaways-home-health-value-based-care-mergers" target="_blank" title="Modern Healthcare: Healthcare consultants weigh in on top trends, challenges">Modern Healthcare poll</a> of 31 health care consulting firms identified the most common areas hospitals and health systems are seeking help.</p><h2><span>Here Are Some Other High-Level Findings</span></h2><ul class="red"><li class="red"><h3>Operational improvements remain a top focus.</h3><p>Four out of five responding firms said their hospital and health system clients are seeking help in this area, including:</p><p><img src="/sites/default/files/inline-images/Operational-improvements-digital-health-transformation-finances-patient-safety-real-estate.png" data-entity-uuid="951957d7-e9dc-4b10-bfe4-565214c30f7c" data-entity-type="file" alt="68% Digital health transformation. 61% Guidance on improving finances. 42% Patient Safety. 42% Real estate." width="100%" height="100%"></p></li><li class="red"><h3>Expanding home health care gets greater attention.</h3><p>Home health care models enabled by virtual care, digital front door systems and remote patient monitoring are gaining traction, one respondent noted. Another noted that greater focus on home health care delivery will meet the needs of patients and providers who are trying to minimize hospital visits.</p></li><li class="red"><h3>Cyber-risk management, threat detection need improvement.</h3><p>Despite working with clients in this area and improving readiness and resiliency, consultants said there is much to be learned. Despite an increase in breaches, training to reduce provider downtime and improve business continuity planning after an attack often are underestimated or neglected, one consultant said. Securing needed investment and authority for cybersecurity leaders remains a challenge, said another respondent.</p></li></ul><hr><h2><span>Learn More</span></h2><p>For information on how to improve your organization’s response to cyber threats, attend the AHA Leadership Scan <a href="https://aha-org.zoom.us/webinar/register/1817236608897/WN_6uNdfOWFRuGnd9LM7ATiTw#/registration" target="_blank" title="ZOOM: 09-26-24 Navigating the Health Care Cybersecurity Storm: Strategies for Resilience and Risk Reduction Leadership Scan webinare registration">“Navigating the Health Care Cybersecurity Storm: Strategies for Resilience and Risk Reduction.”</a> The panel discussion, led by John Riggi, the AHA’s national adviser for cybersecurity and risk, will take place from noon to 1 p.m. CT on Sept. 26.</p></div><div class="col-md-4"><p><a href="/center" title="Visit the AHA Center for Health Innovation landing page."><img src="/sites/default/files/inline-images/logo-aha-innovation-center-color-sm.jpg" data-entity-uuid="7ade6b12-de98-4d0b-965f-a7c99d9463c5" alt="AHA Center for Health Innovation logo" width="721" height="130" data-entity- type="file" class="align-center"></a></p><p><a href="/center/form/innovation-subscription"><img src="/sites/default/files/2019-04/Market_Scan_Call_Out_360x300.png" data-entity-uuid data-entity-type alt width="360" height="300"></a></p></div></div></div>.field_featured_image { position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } .featured-image{ position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } ul.red { list-style: none; } ul.red li.red::before { content: "\2022"; color: #9d2235; font-weight: bold; display: inline-block; width: 1em; margin-left: -1em; font-size: 1.6em; line-height: 1.3; } h3 { margin-top: -1.3em; } Tue, 17 Sep 2024 06:00:00 -0500 Home Health /news/headline/2024-09-06-aha-comments-cms-home-health-pps-proposed-rule-cy-2025 <p>The AHA Aug. 26 commented on the Centers for Medicare & Medicaid Services' home health prospective payment system proposed rule for calendar year 2025, expressing <a href="/lettercomment/2024-08-26-aha-comments-calendar-year-2025-home-health-prospective-payment-system-proposed-rule">concerns</a> about ongoing access challenges for beneficiaries needing home health care and the potential for the proposed rule to cause additional disruption. AHA urged CMS to reconsider its proposals and ensure home health agencies receive payment updates reflecting their financial standing to provide high-quality care. Additionally, AHA noted concerns about the proposed rule for long-term care facility Medicare conditions of participation requiring ongoing respiratory virus data reporting. <br> </p> Fri, 06 Sep 2024 13:18:24 -0500 Home Health /lettercomment/2024-08-26-aha-comments-calendar-year-2025-home-health-prospective-payment-system-proposed-rule <p>August 26, 2024</p><p>The Honorable Chiquita Brooks-LaSure<br>Administrator<br>Centers for Medicare & Medicaid Services<br>Attn: CMS-1803-P<br>P.O. Box 8013<br>Baltimore, MD 21244-8013</p><p>Submitted electronically</p><p><em><strong>Re: Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies; 89 Fed. Reg. 55,312 (July 3, 2024).</strong></em></p><p>Dear Administrator Brooks-LaSure:</p><p>On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, including approximately 1,000 hospital-based home health (HH) agencies, and our clinician partners — more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) appreciates the opportunity to comment on the calendar year (CY) 2025 HH prospective payment system (PPS) proposed rule.</p><p><strong>The AHA is very concerned about ongoing access challenges for beneficiaries needing HH care, and the potential for CMS’ proposed updates to lead to further disruption.</strong> HH agencies are vital to Medicare beneficiaries’ recoveries, and they partner with acute care and other hospitals to ensure patients can receive the right care in the most appropriate setting. Hospitals rely on HH agencies for safe and timely discharge of patients and to avoid extended hospital stays. We already see the strain on HH operations — and other post-acute care providers — due to financial challenges, creating ripple effects throughout the continuum of care, including for acute and post-acute hospitals. Despite this, CMS proposes inadequate HH agency payment rate updates and further erroneous behavioral adjustments. <strong>We urge the agency to reconsider these proposals and take steps to ensure HH agencies receive payment updates that match their financial reality and enable them to continue to provide high-quality care to Medicare beneficiaries. </strong></p><p><strong>In addition, the AHA is concerned about the proposed changes for long-term care facility Medicare conditions of participation (CoPs) requiring ongoing respiratory virus data reporting. </strong>We do not believe CoPs are the appropriate lever to impose data reporting requirements, and the proposals are poorly defined.</p><p>We provide additional detail on these issues, as well as other proposals in the rule, below.</p> Mon, 26 Aug 2024 12:20:39 -0500 Home Health /aha-center-health-innovation-market-scan/2024-08-13-4-ways-prep-where-health-care-will-be-delivered-2035 <div class="container"><div class="row"><div class="col-md-8"><p><img src="/sites/default/files/inline-images/4-Ways-to-Prep-for-Where-Health-Care-Will-Be-Delivered-in-2035.jpg" data-entity-uuid="c6eb547b-e1af-44ba-b557-0fbc70b6f189" data-entity-type="file" alt="4 Ways to Prep for Where Health Care Will Be Delivered in 2035. A hospital executive looks through a telescope to see what 2035 has in store for health care." width="100%" height="100%"></p><p>Big changes are coming to health care over the next decade, with technology innovation supporting significant shifts that will necessitate operational changes for providers.</p><p>Technology will continue to get faster, cheaper and smarter. So-called <a href="https://www.graphcore.ai/posts/graphcore-announces-roadmap-to-ultra-intelligence-ai-supercomputer" target="_blank" title="Graphcore: Graphcore Announces Roadmap to Ultra Intelligence AI Supercomputer">“ultra intelligence”</a> artificial intelligence (AI) supercomputers this year are expected to possess four times more parametric capacity than the human brain and be nearly 10 times faster in the number of computations that can be run every second.</p><p>As for how the field will be impacted by the rapidly evolving tech landscape, the consultancy Oliver Wyman recently published an <a href="https://www.oliverwyman.com/our-expertise/insights/2023/dec/fostering-change-in-where-and-how-care-is-delivered.html" target="_blank" title="Oliver Wyman: Fostering Change in Where and How Care Is Delivered">analysis</a> as a follow-up to its <a href="https://www.oliverwyman.com/our-expertise/insights/2023/sep/designing-for-2035.html" target="_blank" title="Oliver Wyman: Designing a Healthcare System for the Next Decade">Designing for 2035 report</a>.</p><h2><span>Forecasting for 2035</span></h2><p>Among the authors’ projections:</p><ul><li><strong>Health care costs will continue to come down</strong> even as workforce expenses and the actionability of data collected remain challenges.</li><li>By 2035, <strong>comprehensive genome sequencing</strong> will be a standard part of medical evaluations, providing insights into an individual’s predisposition to diseases and guiding personalized treatment plans.</li><li><strong>Advanced diagnostic capabilities will expand.</strong> Point-of-care devices and at-home testing kits will provide quick and accurate results for a wide range of conditions, enabling early detection and timely treatment.</li><li>Pharmaceutical companies will <strong>use predictive models to design and test potential drugs</strong> in a matter of days or weeks rather than the years it now takes. Doing a better job of incorporating data into clinical workflows will help ease the burden and burnout that clinicians currently feel from cumbersome technology systems.</li></ul><p>The overall increase in information on outcomes and practice patterns, along with more effective dissemination of data, will enable faster and more accurate treatment decisions. Current struggles with interoperability will be overcome, and data will follow patients in a more efficient manner.</p><h2><span>4 Takeaways for Provider Organizations</span></h2><h3><span>1</span> <span>|</span> Focus on value-added clinical tasks.</h3><p>Some current technological advances already are providing administrative support. Further improvements will come from modifying ChatGPT-like solutions for creating more efficiencies of back-office and other administrative functions. Additionally, AI will support and evolve work completed by nurses, case managers and social workers. Smart implementation of AI systems has the potential to fully automate some tasks, including prior authorizations, care planning and consultations triggered by assessments.</p><h4><span>2035 Outlook</span></h4><p>Keep an eye on robotic medication administration. These systems can identify routine drugs that serve select patients. While these advances significantly will improve everyday efficiency, the rate of adoption will be limited by cost and resource shortages, the report notes. Once this barrier is overcome, hospitals can implement fully baked solutions to optimize operations.</p><h3><span>2</span> <span>|</span> Redistribute care to optimal settings.</h3><p>Hospitals have been important sites of care for two main reasons: economies of scale — reducing the unit cost of care delivery through asset utilization and economies of scope — and using various capabilities and expertise to bend the cost curve and respond to patient variance. But as care delivery has advanced, the impact of economies of scale and scope has diminished. Scale no longer requires being everything to everyone. Likewise, scope needs are lessened through the ability to manage risk and reliance on more precise diagnoses.</p><h4><span>2035 Outlook</span></h4><p>The current inpatient model is capital- and staff-intensive and therefore expensive. It also is not always the safest or most consumer-friendly place to be treated, the report states. Patient preferences and logistics may make being at home the optimal site of care and the authors predict care settings will shift dramatically over the next decade.</p><h3><span>3</span> <span>|</span> Move care from inpatient to outpatient where appropriate.</h3><p>Coming tech advances will lessen the need for inpatient admissions for certain conditions and surgical procedures. Shifts in care protocols, including minimally invasive procedures and improved rehabilitation techniques, will accelerate this transition.</p><h4><span>2035 Outlook</span></h4><p>Expect retail clinic settings to have an impact in this area with their easy accessibility, lower cost structure and a strong focus on preventive care.</p><h3><span>4</span> <span>|</span> Explore moving some inpatient services to home care.</h3><p>The most disruptive transition between now and 2035 could come in this area. The authors project that 64% of inpatient admissions could be moved to the home by 2035, enabled by both improved therapeutics and more effective virtual care.</p><h4><span>2035 Outlook</span></h4><p>At-home care has limitations. Shifting out of an inpatient setting is not feasible for high-risk situations or overly invasive procedures. And not everything that is available to move to the home should, the report states.</p><p>The overall infrastructure still isn’t robust enough to match the potential transition. Only about 40% of U.S. homes were considered to have the most basic aging-ready features, according to a <a href="https://www.census.gov/newsroom/press-releases/2023/aging-ready-homes.html#:~:text=Highlights%3A,aging%2Dready%20homes." target="_blank" title="United States Census Bureau: Census Bureau Releases New Report on Aging-Ready Homes">2023 Census Bureau report</a>, and large areas of rural America, as well as some inner cities, still lack <a href="https://www.census.gov/newsroom/press-releases/2024/computer-internet-use-2021.html" target="_blank" title="United" states census computer and internet use in the united>access to broadband</a>. Still, significant growth could occur in the home care setting.</p></div><div class="col-md-4"><p><a href="/center" title="Visit the AHA Center for Health Innovation landing page."><img src="/sites/default/files/inline-images/logo-aha-innovation-center-color-sm.jpg" data-entity-uuid="7ade6b12-de98-4d0b-965f-a7c99d9463c5" alt="AHA Center for Health Innovation logo" width="721" height="130" data-entity- type="file" class="align-center"></a></p><p><a href="/center/form/innovation-subscription"><img src="/sites/default/files/2019-04/Market_Scan_Call_Out_360x300.png" data-entity-uuid data-entity-type alt width="360" height="300"></a></p></div></div></div>.field_featured_image { position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } .featured-image{ position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } Tue, 13 Aug 2024 06:15:00 -0500 Home Health