This article is sponsored by KanTime. In this Voices interview, Hospice News sits down with Deanna Heath, VP of Hospice, KanTime, to talk about the potential impact of the Value-based Insurance Design (VBID) model on today’s hospice landscape. She lays out some of the key steps hospice providers can take to prepare for VBID, including how KanTime’s technology can help with that process.
Hospice News: What career experiences do you most draw from, in your role today?
Deanna Heath: I have worked in the post-acute space since 2003 with a focus in hospice. I have done everything from bedside nursing to administration, and my last eight years at the agency level were spent as a quality assurance coordinator. In that role, I worked on improving outcomes and surveys along with chart reviews, which are critical to my role as the VP of Hospice and Palliative Care Services today.
A VBID model would completely rework how the Hospice benefit is offered. Can you walk us through that landscape?
Commonly known as the Medicare Advantage hospice carve-in, the Value-Based Insurance Design (VBID) model officially launched on January 1, 2021, with 53 Medicare Advantage Plans offering the benefit in 206 counties within 13 states and Puerto Rico for 4 years ending in 2025. This pilot program is the likely model for hospice in the future, creating a more complex dynamic in an already challenging field.
For the first time ever, the model will test the carve-in of the hospice benefit into Medicare Advantage with the provision of palliative care, transitional concurrent care and supplemental benefits — all spliced and bundled into the VBID model. Hospice would likely change from the Medical Director-led IDT team with standard COPS, to a landscape of payer-source-driven rules for each patient.
The agency would be charged with not only building their own network of supplemental services contracts, but also being tasked with remembering the rules. The difference is Medicare Advantage vs Humana VBID. KanTime’s model of payer-rule-driven guardrails would take one burden away as KanTime remembers the MAO rules so that the agency or end user doesn’t have to.
What are some of the changes providers can expect to see in the 3rd and 4th years of VBID?
In the first two model years, the choice remains with the patient to choose an in-network or out-of-network provider, but the Medicare Advantage plan can have a consultation with the patient prior to hospice selection to advise on the differences in benefits. It is important to note that only patients who are serviced by in-network providers will be able to access those palliative care, transitional concurrent care and supplemental benefits.
Also, in the first two years, participating Medicare Advantage organizations may not charge higher cost-sharing for hospice services provided in-network or out-of-network than those levels permitted under Original Medicare.
It is important that hospices have the right person performing contract negotiations — someone who is not only familiar with the services an agency provides, but who is also equally knowledgeable of what is beneficial to the plan. The ability to present customer satisfaction scores, attention to HQRP measures and a means for providing quality hospice services in a cost-effective manner directly impacts those plans.
Additionally, it is important that the person performing contract negotiations is well versed on the rates being negotiated, as well as the services an agency is committing to, beyond the standard practice of care they’ve employed for years.
How will VBID impact an already challenging job market in hospice?
VBID looks to make remembering the rules more challenging for not only the agency, but also the field clinician. Instead of practicing inside of the traditional model, clinicians will need to easily understand what model or mix of models a client is being serviced under.
KanTime can capture affiliated providers, documents and palliative care-to-hospice transitions seamlessly by overlaying medical records for easy reference. KanTime believes longitudinal care is here, and having an EMR solution built for the post-acute care continuum will make following the patient easier for the organization and the field clinician. Success in this challenging job market will come down to hiring the right people for the right job, at the right salary while giving them the tools necessary to perform as efficiently as possible.
How can technology solutions like KanTime help providers adapt to these changes?
As a web-based software, KanTime has the flexibility to adapt to the ever-changing regulatory landscape. KanTime, with its experience in VBID for home health, has a knowledge base and expertise to ensure adaptability.
KanTime Software focuses on specific payer rules to drive compliance and ensure that providers are able to bill timely and correctly. Along with helping them remember the rules, KanTime also pushes clinical and financial oversight data to the organization’s leadership in real time. This easily digestible data allows the leadership to rapidly push out and monitor clinical changes that affect compliance and revenue cycle management. Kantime ultimately allows the organization to focus management resources on the most valuable resource — people — rather than the EMR.
What are some of the key steps providers can take to best prepare for VBID in 2023 and beyond?
Providers can prepare for the increased workload coming with VBID by educating staff and making infrastructure decisions in anticipation of this model. In addition to reweaving how hospice is provided — the network creation at the agency level, the negotiation of contracts, the clinician burden of keeping track of the patient’s “network” — agencies will still be working within the current revenue limitations of our existing market.
Leveraging resources now enables organizations to ease into these waters over time instead of taking the plunge all at once. The billing burden also looks to increase as well. Regardless of whether you are in-network or out-of-network, an existing CMS requirement says that hospice providers must submit Notice of Elections, transfers, and revocation transactions, and claims to both their MAC and Medicare Advantage plans.
To be clear, that is double the number of claims and hospice election, transfer and revocation transactions that need to be submitted currently under the traditional Medicare hospice Part A benefit. It is not clear whether or not CMS will relax this “double submission” requirement in future model years. But until such time, it’s important for hospice providers to understand if their vendor or clearing house is able to submit primary Medicare hospice claims and election, transfer or revocation transactions to two different payer entities at the same time.
KanTime is ready for this both clinically and financially. Clinically, we can track other affiliated MDs and suppliers of Pharmacy, DME and even consulting physicians. Billing in KanTime is streamlined and set up to bill that secondary claim.
Finish this sentence: “The hospice industry in 2023 will be the year of…”
Increasing OIG and payment scrutiny
Editor’s note: This interview has been edited for length and clarity.
KanTime streamlines all aspects of your agency from beginning to end. From patient intake to scheduling, billing, and payments, our solutions allow you to do what you do best – deliver quality care to your patients. To learn more visit kantime.com/care-type/hospice-management-suite/
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact firstname.lastname@example.org.