Home Care Again Named Among Fastest Growing Jobs

The US Bureau of Labor Statistics again named home health aides and home care aides as two of the top three fastest growing jobs over the coming years.

The Boston Globe featured these jobs as a special section on their website. Of course, many healthcare occupations and especially those in the community, will see large increases to support the expected massive growth in the elderly population.

To search for jobs in home care in Massachusetts, visit our job bank.

Return to www.thinkhomecare.org.

State Senate Budget Includes Telehealth

The state senate this week passed a $30.5 billion state budget for FY 2012 that included a major priority of the Home Care Alliance.

An amendment instructing MassHealth to reimburse for telehealth remote patient monitoring provided by a home health agency was adopted by the Senate.  That provision must now survive a conference committee made up of House and Senate members who will work out differences between the House and Senate budget proposals and send the finished version to the Governor for his approval.

The amendment passage is a victory for home health care and reflects a greater understanding from the state legislature on issues important to the industry. Moreover, the adoption of the telehealth amendment, while only a first step in the process, is also recognition of the cost savings that home health agencies and the use of technology can provide.

Most of the 599 budget amendments proposed in the Senate did not make it through, including restoration of MassHealth rates of payment for home health past 60 days, a pediatric home care amendment, and another that would have established a special care transitions rate for home care agencies.

Two amendments regarding adult day health were also adopted.  One would establish licensure standards for adult day health providers and the other would require MassHealth to notify the legislature of any changes to rates or clinical eligibility criteria for adult day health services.

Other amendments of note include:

  • An amendment was adopted that would require MassHealth to annually notify each beneficiary over 65 about their options regarding enrollment in voluntary programs, including Program of All Inclusive Care for the Elderly (PACE) plans, MassHealth Senior Care Options, Frail Elder Home and Community Based Waiver Program and “any other voluntary elected benefit to which such beneficiary is entitled to supplement or replace such beneficiary’s MassHealth benefits.”
  • An amendment was rejected that would allow nursing homes to place a hold on beds for residents who are transferred to the hospital for emergency care.
  • An amendment was adopted to provide an additional $1 million for elder protective services (total amount: $16,250,554).
  • An amendment was adopted to provide an undisclosed amount of funding to elder pre-admission options counseling.
  • An amendment was adopted providing an additional $4 million for Day Habilitation Services
  • The Salary Reserve for human service workers was not approved, but the Senate did approve a substitute amendment enable human service provider agencies to purchase health insurance through the Commonwealth Health Insurance Connector for their employees earning less than $40,000/year.

For any questions or further information on the state budget, contact James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

Advocacy Messages Now Available for Senate Budget

The Home Care Alliance has several important amendments filed in the FY 2012 Senate budget and messages to support these initiatives are available here.

Here are the issues HCA is advocating for:

Amendment #483Home Health Care Rates, filed by Senator Michael Moore.

  • The MassHealth home health payment rate was cut by 20 percent to patients receiving skilled nursing care past 60 days of care in December of 2008. This created a new payment category that goes from $86.99 to $69.59 for patients that require longer periods of care and who are at a greater risk of inpatient facility admissions or readmissions.
  • Since all of MassHealth’s home health services receive a 50 percent federal match, the actual state expenditures reflect only half of a $7.1 million budget increase.

Amendment #478MassHealth Home Care, filed by Senator Steven Tolman.

  • This amendment establishes a special MassHealth rate to reward home health agencies that are successful in helping patients discharged from acute care avoid a costly re-hospitalization for the same condition for which they were originally hospitalized.
  • The hospitalization would have to be avoided for at least 30 days in order for the payment to be administered. The Secretary of Health and Human Services shall determine the rate, which will be based on a nurse-led team model.
  • This provision would increase the efficiency of care and save costs for the state in avoiding rehospitalizations.

Amendment #481Pediatric Home Care Services, filed by Senator Michael Moore.

  • This amendment does not increase any rate, but merely shifts existing payment recognizing a home health agency’s administrative requirements. Also, this amendment ensures safety and quality by allowing only registered nurses to care for multiple patients in a single setting.

Amendment #593 –  Telehealth Reimbursement, filed by Senator Richard Moore.

  • In recent years, several states have all moved forward with incorporating coverage of telehealth into their state plan, waiver home care programs, or have authorized funding for demonstration projects to support telemonitoring equipment purchases.
  • The Centers for Medicare and Medicaid Services also recognize and define telehealth billing and reimbursement practices.
  • Telehealth and remote care management programs are not only proven to reduce admissions to hospitals and nursing homes, but also reduce the frequency of home health visits.
  • Such lower cost services increase communication with physicians and caregivers, which contributes to the enhancement of care. It also increases patient self-management and is widely regarding as a cost savings measure supported by a number of studies and pilot programs.

Amendment # 589Adult Day Health Services, filed by Senator Richard Moore.

  • A $55 million cut to Adult Day Health (ADH) services was proposed in the Governor’s budget and this amendment would freeze the current level of reimbursement to prevent that reduction from occurring. The amendment would also impose a moratorium on new ADH facilities until a study on ADH rates and services is completed by the Executive Offices of Health and Human Services and Elder Affairs.

Amendment #586 – MassHealth/Medicare Dual Eligible Demonstration Project, filed by Senator Thomas Kennedy.

  • The Patrick administration is exploring a demonstration program that would offer a new integrated care product to MassHealth members that are dually-eligible for Medicare.  The new program would apply to individuals who are eligible for both Medicare and Medicaid, and who are between 21 and 65 years old.
  • The proposal envisions the MassHealth program receiving Medicare funds from the federal government for the purpose of managing the care of dual eligible patients.  MassHealth would then pay “Integrated Care Entities” a global payment for the care of a group of enrollees.
  • The governor’s FY2012 state budget recommendation assumes $50 million in savings from the proposed initiative. MassHealth states these savings will be achieved by better coordination and management of the dually eligible population.  While the $50 million savings estimate is not based on provider rate reductions, legislative guidelines for this dually-eligible demonstration effort are needed to assure hospital, physician, and home health care payments continue at current Medicare levels.

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Hearing Kicks-off Public Comment Period on Payment Reform

A packed hearing in the State House’s Gardner Auditorium on Monday kick-started the conversation on what is likely to be the biggest change in the Massachusetts health care delivery system since the state passed universal coverage in 2006.

The Governor’s payment reform legislation would move the system of paying for all health care in the state from a fee-for-service model to more of a global payment model, with accountable care organizations responsible for delivering quality care in a manner that slows the growth of spending.

Much of the testimony and discussion is centering on how prescriptive the legislation will be in terms of mandatory versus voluntary participation, and the composition and authority of various oversight boards and advisory committees. Rey Spadoni, President & CEO of the Visiting Nurse Association of Boston and James Fuccione of the Home Care Alliance presented testimony regarding the need to recognize the importance of including the full continuum of care in any ACO model and central role that home care can play in a system that becomes more patient-centered, more cost conscious and accountable.

The Alliance, in particular, has asked in its testimony that the legislation be amended to require at least one home health/post-acute provider to be included on every ACO’s governing body.  The VNAB testimony asked that the new model recognize home health’s “investments in technology, clinical centers of excellence that serve patients with chronic disease, staff training and the addition of support services designed to keep people at home and independent or achieving the highest quality of life levels possible for them.”

The Home Care Alliance strongly encourages every interested agency to submit written testimony, which can be sent to the Alliance to collect and forward on to the Joint Committee on Health Care Financing, or to show up at public hearings being held across the state at the dates below:

  • Monday, May 23 at 11:00 a.m. at UMASS Medical School, Worcester (55 Lake Avenue North, 6th Floor of the medical school, Amphitheatre 3)
  • Monday, June 6 at 11:00 a.m. at Salem State University, Salem (71B Loring Avenue, Central Campus, Marsh 210)

The Alliance needs members to offering verbal or written comments if we are to be successful in carving an explicit role for home care into the ACO model.

The Home Care Alliance previously released a position paper on ACO’s prior to the Governor’s legislation that can be used to guide comments.

Return to www.thinkhomecare.org.

HCA Revamps Physician Face-to-Face Guidance

The Home Care Alliance has newly revamped documents available for helping home health agencies work with physicians relative to the face-to-face encounter requirement.

Please feel free to utilize and distribute the documents below, which include a fact sheet on the requirement, a sample documentation guide, and a tip sheet for terms that can be used in the “brief narrative” portion of the document.

The Home Care Alliance continues to work with association partners such as the Massachusetts Medical Society, Massachusetts Hospital Association, Mass Senior Care, LeadingAge Massachusetts and others to ensure that physicians in every setting know about and properly cooperate with the requirement.

Return to www.thinkhomecare.org.

New Materials and Guidance for CMS Care Transitions Program

A pair of presentations with helpful information and resources regarding the CMS Community-Based Care Transitions Program have been made available.

For home health agencies interested in applying or just getting started with the process, this CMS PowerPoint provides a good summary of the information, helpful links and resources, and answers to some of the more frequently asked questions.

Another helpful set of presentations sponsored by the Commonwealth Fund is available and includes a webinar with audio featuring:

  • Anne-Marie Audet, M.D., M.Sc., moderator, vice president, Quality Improvement and Efficiency, The Commonwealth Fund
  • Eric Coleman, M.D., M.P.H., director, Care Transitions Program, and professor of medicine at the University of Colorado Health Sciences Center
  • Garry MacKenzie, M.D., medical director of cardiology services at McKay-Dee Hospital Center in Ogden, Utah
  • Janice Fitzgerald, R.N., director of quality and medical management at Baystate Medical Center in Springfield, Mass.
Lastly, there have been a lot of questions regarding how to proceed with the “root cause analysis” in the application. A very helpful resource to assist in this matter is available courtesy of the Care Transitions Quality Improvement Organization Support Center (QIOSC).
More updates and resources will be provided by the Home Care Alliance as they become available.

Disaster Prep – Is Your Agency Ready?

Home care agencies have unique responsibilities to their clients during disasters, epidemics, and terrorist attack.

But they also have unique resources. The simplest way to prepare for a disaster is to speak to your clients about the matter and to encourage them to take precautions and make plans.  A great starting point is the new Disaster Preparedness: For Seniors By Seniorsbrochure from the American Red Cross.  This handsome, 13-page brochure covers all the basics — with special attention to seniors including:

  • Building a disaster kit (including medications);
  • Planning an escape route;
  • Staying informed after a disaster takes place; and
  • Knowing what resources are available;

Best of all, the Massachusetts Dept. of Public Health is making copies available free of charge.  Just download the order form, send it in, and they’ll send you up to 500 copies.

Even more importantly, disaster preparedness is vitally important — literally — for home care agencies. That’s why the Alliance partnered with DPH to develop the the Home Health Care Emergency Preparedness Handbook. The Handbookpresents Alliance best practices for preparing for natural disasters, epidemics, and terrorism. Contents include:

  • Standards of Care;
  • Infection Control;
  • Patient Tracking Controls;
  • Emergency Communication Resources;
  • Home Health Care Emergency Planning Resources;
  • Emergency Planning Training Resources;
  • Volunteer Opportunities

The Handbook also contains extensive appendixes on:

  • Hazard Vulnerability Analysis
  • Biological Weapons Agents
  • Emergency Policies & Procedures
  • CMS Altered Standards of Care

The Handbook comes in a three-ring binder and is available to Alliance Members for $25/copy, or $100 for five copies.

Return to www.thinkhomecare.org.