Health Care Matters | October 11, 2024
AHCAH Evaluation Report
The Centers for Medicare & Medicaid Services (CMS) released its report on the study of the Acute Hospital Care at Home (AHCAH) initiative. The study of the AHCAH initiative used available quantitative and qualitative data to draw comparisons between the AHCAH and brick-and-mortar hospital inpatient comparison groups. The study found that AHCAH inpatient stays had lower mortality rates and lower Medicare spending in the 30 days following discharge compared to brick-and-mortar inpatient stays. The 30-day readmission rates were varied, with significantly better results in the AHCAH stays for some conditions while brick-and-mortar inpatient stays had better readmission rates for other conditions.
Why It Matters
In the midst of the COVID-19 pandemic in 2020, CMS granted AHCAH waivers for individual hospitals to provide inpatient-level care in the home environment to Medicare fee-for-service and non-managed care Medicaid beneficiaries. The waivers were extended by Congress and are set to expire in December of 2024. The CMS report notes several limitations of the study including differences between the ACHAH patient population and those served in brick-and-mortar settings and COVID-era trends that may not be predictive of current or future results. Notably, patients treated under the AHCAH waiver were more likely to be white and living in urban areas and less likely to qualify for Medicaid or low-income subsidies than the broader population receiving services from the same hospital. While the report does not provide a definitive endorsement of the AHCAH initiative, the study’s mostly positive findings around cost and positive patient and caregiver feedback could influence lawmakers as they decide whether to extend the waiver beyond this year.
Modern Healthcare’s 2024 Physician Compensation Survey
Modern Healthcare released its 2024 Physician Compensation Survey which reflects data from 10 staffing and consulting firms. The survey shows that while physician compensation continues to rise among most specialties, the physician shortage is not improving and is forcing a shift in employer contracting strategies.
View a summary of the report here.
Why It Matters
To combat the increasing physician workforce challenges, these data highlight the need for employers to use innovative compensation strategies to remain competitive. Employers are shifting their recruitment and retainment strategies to include more than just higher salaries, offering contracts that incorporate incentives such as housing assistance, stipends to residents and fellows, and retention bonuses. While enhanced compensation packages make it easier to attract and retain top talent, addressing physician shortages, ensuring a stable workforce, and working to address burnout, it doesn’t come without potential challenges to the health care sector. Higher compensation packages can strain budgets and could exacerbate disparities in access, particularly if resources are disproportionately allocated to certain specialties or geographic areas. Additionally, US health care has seen dramatic increases in ownership of physician practices by private equity (PE) over the last five years. PE investments can provide essential capital for expanding resources and improving infrastructure, however, there is significant industry concern about the potential impacts on quality of care. Overall, this shift represents a complex balancing act between improving physician satisfaction and retention, managing financial sustainability, and ensuring equitable access to high-quality care.
Harris’ Medicare Long-Term Home Care Proposal
Democratic presidential nominee, Vice President Kamala Harris, recently unveiled an initiative aimed at transforming Medicare by expanding its coverage to include long-term home care services. If implemented, the proposal would offer seniors home care services such as support with bathing and eating that today can typically only be accessed through Medicaid or via long-term care insurance or self-pay.
Read more here.
Why It Matters
As reported by Politico and others, there is bipartisan support for increasing home-based care, but there are certainly no guarantees that such a proposal would be passed by Congress. Among the biggest questions are how to fund this type of benefit expansion. The actual costs of such a program aren't certain as they would depend on details such including cost-sharing. Harris has argued the costs would be offset by savings from further Medicare drug pricing reforms but it's unclear if that would be sufficient to offset costs. Still, the announcement is indicative of growing support for providing care in the home and greater awareness of the shortcomings of long-term care access in the US.
What We Are reading
Unmet Dental, Vision and Hearing Needs Among Low-Income Medicare Advantage Beneficiaries
In this Health Affairs article, researchers found that regardless of plan benefit generosity, low-income beneficiaries were more likely to report dental, vision, and hearing unmet needs because of cost. The article calls for policymakers to monitor supplemental benefits for equity and access, and assess the value added by quality bonus payments to high-rated plans for beneficiaries’ access.
The Racial Health Equity Progress Report
Leaders of a nationwide initiative share preliminary results from testing a quality improvement tool designed to evaluate a health care organization’s efforts to address racial health disparities and other health inequities, while providing a roadmap for organizational improvement.
What We Are Attending
Virtual Congressional Briefing: Advancing Women’s Health and Patient-First Care through Innovation and Payment Reform
Thursday, October 17, 2024
2:00-3:00pm ET
Register here.
