NAHC President Bill Dombi Shares 2022 Outlook & Predictions

The National Association for Home Care & Hospice (NAHC) President Bill Dombi recently presented a 2022 industry outlook webinar, discussing the big issues impacting home care and hospice now and in the future.

One particular area of interest was in a topline poll conducted with the attendees: Home health and hospice leaders overwhelmingly (67%) said the workforce shortage is their greatest concern. Next on the list was preparing for value-based purchasing contracts (14%), followed by payment rates (9%) and vaccine mandates (6%).

“We are faced with a demand that is currently exceeding workforce supply,” said Dombi (18:57).  “This is an issue that affects all of a society … a message that we have been pushing.”

Dombi stated that all of society is affected by this workforce shortage in homecare. Case in point: when an elderly parent can’t get the care they need, a family member has to take off work to care for mom, who then can’t be at home to care for their child. “That trickledown effect becomes more like a flood of impact to the economy at large,” he noted.

Other big areas Dombi noted to watch in 2022 are increasing Medicare Advantage enrollment, expanded use of Managed Medicaid Long Term Services and Supports, growth in Accountable Care Organizations, new competition as care delivery models change and the 2022 election.

Here are some of the top questions attendees asked in the webinar:

1. With our workforce shortage, especially with nursing, what are NAHC/legislative thoughts on allowing other disciplines to complete the start-of-care assessment even when nursing is involved?

   This proposal has been presented to CMS, which has the power to do it without legislation. However, it was necessary to resort to legislation to get authorization for OTs to do the initial assessments. That is a signal that CMS may not be very open to the change.

    

2. We have had to dramatically increase wages. What are your thoughts about the possibility of larger than usual Medicare payment increases?

   Medicare rate increases are tied to the market basket index formula which is based on a combination of cost inflation data (often two calendar quarters old) and a forecasting calculation that is intended to reflect cost trends.

   The history of that methodology shows fairly high accuracy in the forecasting leaving CMS and Congress with an impression that both inflation and deflation in costs are fairly well captured. That said, we certainly are using the recent staff cost changes to both advance increased support in home care, but also to argue for action to stop pending cuts such as the 2% sequestration.

    

3. What are the chances Choose Home legislation will pass?

   The Choose Home Care Act of 2021, S. 2562/H.R. 1544 is a cost-effective, patient preferred, home-based, extended care benefit as a supplement to the existing home health benefit. Dombi noted NAHC is doing everything they can to get the legislation to cross the finish line in 2021. He urged listeners to contact their elected officials to advocate for Choose Home. “Everyone listening in has a power they need to exercise … and you’ll be surprised how powerful you can be,” Dombi concluded.

    

4. Why is palliative care under home health and not under hospice?

Palliative care coverage is under both home health and hospice in our advocacy efforts. The universe of palliative care needs extends beyond hospice and end-of-life care. As such, there is a need to modernize Medicare to encompass the full range of palliative care needs.

Be sure to tune in to this in-depth, expert briefing from a Washington D.C. insider you cannot get anywhere else. Watch the full webinar here.