Surabhi Dangi-Garimella

Here’s Some Good News: CMS to Pay for Navigators, Caregiver Training

The 2024 Medicare Physician Fee Schedule surely checks the box for being patient-centered. Starting this year, Medicare will start paying health care practitioners for taking the time to train family caregivers so that Medicare enrollees can appropriately follow their treatment plan.

Training family caregivers to care for older patients at home—be it medication management or doing household chores—reduced the likelihood of acute care utilization. This is particularly relevant after older patients are discharged and have to continue their recovery at home: 20% of older adults are readmitted to the hospital within 30 days of discharge. Family caregivers, who may already be juggling their work and family life, may feel overwhelmed with the added responsibility of caring for a recovering older parent. Providing them with appropriate resources and training can help reduce their burden and also lead to improved health outcomes for the patients.

The second important part of the announcement is that patient navigation services will now be reimbursed—namely, care navigation for patients with high-risk diseases including cancer.  

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The importance of cancer navigators cannot be overstated, not just for those who are newly diagnosed but also for those who have been under treatment for a while. With the time that a navigator invests in a patient and their family members (a systematic review of 61 studies conducted over a decade identified this to be anywhere between 5 minutes to 3 hours), they are able to personalize the support that a patient needs. They can assist patients and their families with:

    • Practical needs (such as transportation, lodging, finances, interpretation)

    • Physical needs (such as dealing with side effects, need for hair wigs, referrals for home/palliative/hospice care)

    • Social and emotional needs (referrals for counseling, stressed relationships, dealing with changes in appearance)

While alleviating the stress felt by patients and their family members, studies have shown that integrating navigators in a cancer program helped retain patients within the program and also helped prevent hospitalizations and visits to the emergency room. With navigators filling in, physicians reported on reduced administrative burden (such as ensuring patients are seeing the right specialists in a timely manner), that in turn lowered physician burnout and errors.

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Supporting Family Caregivers of Medicare patients

2020 data from AARP and the National Alliance for Caregiving show that an estimated 53 million adults in the U.S. are unpaid caregivers to an adult or a child, of which 48 million are caring for someone over the age of 18 years. 

  • 61% of these caregivers are working adults
  • 42 million are caring for someone over 50 years of age
  • Disproportionate number of these caregivers are women

The US Census Bureau estimates that 19 million individuals will be over 85 years by 2060, 3X that of 2020: who will care for them? Empowering family caregivers to allow in-home care will be ideal, because seniors prefer to stay within the comfort of their home and with family members instead of a hospital or long-term care facility.

What can the federal government do to support in-home care?

 

  • Increase Access to In-Home Benefits and Support for Family Caregivers Within Medicare (Traditional as well as MA)
    • Beneficiary access to personal care and skilled care services at home
    • Incentivize MA plans to provide supplemental benefits (personal care, respite care for caregivers) and social determinant of health benefits (food, transportation)
    • Coordinated care and enhanced benefits: assistance with healthcare navigation, care management, telehealth, post-hospitalization home care
    • CMS could test these pilot programs and their impact on preventing hospitalization and nursing home admissions
  • Educate and encourage health care providers to use existing billing codes for services such as caregiver health risk assessment, training and care management
  • CMS can enforce rules that ensure family caregivers are included in the beneficiary’s care plan, such as transitions across care settings and discharge planning
  • CMS can launch pilot programs that compensate family caregivers for their services and time
  • Make data-driven decisions: prioritize data collection on caregiver needs, focus on using appropriate performance measures to capture caregiver health and wellbeing, include caregiver-related questions in patient satisfaction surveys

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New Test to Detect Familial Cancer Can Predict Risk for Multiple Cancer Types

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The FDA has approved a genetic test that can detect variants of 47 cancer-causing genes following a simple blood draw. Some of the genetic mutations and the associated cancers that this test can detect include: 

  • BRCA1 and BRCA2: hereditary breast and ovarian cancer syndrome
  • MLH1, MSH2, MSH6, PMS2 and EPCAM: Lynch syndrome (can increase risk for colorectal, endometrial, ovarian, gastric, pancreatic, renal, and brain cancer)
  • CDH1: hereditary diffuse gastric cancer, and lobular breast cancer syndrome
  • STK11: Putz-Jeghers Syndrome

It is important to note that a conversation with your doctor and/or a genetic counselor is important to understand the implications of the test results and to understand the need for monitoring or potential treatment. Additionally, this test does not evaluate all known cancer-causing genes. Finally, false-negative results could provide misleading assurance that all is fine, while false-positive results could lead to unnecessary monitoring and/or lifestyle changes.

In an email correspondence, the company said the test costs $250 without insurance. Cost will vary for those who have insurance, based on their specific plan.

 

Additional Resources for Those Who Want to Know More:

Genetic Testing for Familial Cancer Syndromes   

Genetic Counseling and Assessing Cancer Risk

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