Home Care Accreditation Reaches 60 Agencies

The Home Care Alliance is proud to announce that the Home Care Accreditation Program offered to private pay agencies, has now reached 60 providers!

See our press release on this important milestone below:

Home Care Accreditation Program Reaches 60 Agencies

New Stricter Standards for Private Pay Home Care Providers

Boston, MA – With brand new standards that are more stringent to protect patients, improve quality care and promote ethical business practices, the Home Care Accreditation Program offered by the non-profit Home Care Alliance of Massachusetts for private pay home care providers, continues to grow and has now reached it’s 60th agency.

“These new standards for Accreditation raise the bar for agencies, which only can lead to positive things for patients looking to remain independent in their homes,” said Home Care Alliance Executive Director Patricia Kelleher. “We hope the public realizes that this simply isn’t a stamp of approval, but a strong display of our commitment to quality and assurance that these agencies are meeting strict standards. Families deserve that peace of mind that their loved ones are receiving the best services out there.”

In the absence of meaningful licensure requirements for providers of home care services in Massachusetts, the Home Care Alliance established this Accreditation Program for Private Pay agencies, which do not receive reimbursement from Medicare or Medicaid.

The standards were developed over several months in consultation with 14 agencies throughout the Commonwealth.  These standards require that agencies submit an application and documentation to the Home Care Alliance of Massachusetts.  Alliance staff and member agencies then review the application to ensure that applicants meet all of the standards. Recently, the Home Care Alliance’s Board of Directors approved stronger standards that are meant to show the organization’s commitment to maintaining quality services.

Agencies seeking accreditation answer questions in fifteen categories, including training requirements, administrative protocols, and business practices.  They are required to show documentation in answer to questions regarding service plans between clients and the agency, procedures around responding to complaints, and their oversight of caregivers.

“We wanted to provide leadership for an area that is becoming more and more important in Massachusetts,” added Kelleher, “These standards highlight our agencies’ best practices, which will help guide members of the public as they choose who will take care of their loved ones in their homes. We aim to approve as many private care agencies as we possibly can in Massachusetts to prove our state’s commitment to quality home-based care.”

A full list of accredited agencies from across the state, and more information about the Accreditation Program standards, is available at www.thinkhomecare.org/accreditation.

Return to www.thinkhomecare.org.

HCA Comments to Federal Deficit Reduction Committee

With a home health copayment and other potential hazards hanging in the balance, the Home Care Alliance sent off an official letter to the Joint Select Committee on Deficit Reduction to reiterate strong opposition to what would amount to a “sick tax” on certain Medicare patients.

Following up on the recent visit to Washington DC, the letter was sent to the co-called Super Committee, which includes Massachusetts Senator John Kerry, and was copied to the state’s Congressional Delegation. The letter was especially timely, as a group of Alliance members and staff met last week with Senator Kerry to discuss specific concerns.  

The Alliance particularly targeted a recent proposal from President Obama to institute a copayment for Medicare home health services. If passed, the copayment would amount to $100 per 60-day episode on certain Medicare beneficiaries beginning in 2017. The copayment would not be imposed for episodes following a stay in an acute care facility and would apply to patients receiving five or more visits.

The Alliance’s letter, aside from opposing the copayments, also points out that Massachusetts has not experienced the same growth in the number of home health agencies as other parts of the country.  The Alliance argues that such broad payment reductions or copayments are punishing the wrong people and not targeting offenders of fraud and abuse. The Alliance also offers alternatives like a moratorium on new certified agencies, better targeting fraud and abuse in areas of substantial growth, and further capping outlier payments.

Agencies and concerned advocates are encouraged to submit comments opposing the copay and offering alternative solutions as mentioned in the Alliance’s letter to the Joint Committee on Deficit Reduction by visiting the comment submission page of their website.

The Alliance also has the opening remarks of Committee Co-Chair Senator Patty Murray (D-Washington) on the HCA YouTube page and will continue to provide updates as they become available.

Return to www.thinkhomecare.org.

HCA Issues Statement on Home Care Copay Proposed by President

In response to President Barack Obama’s proposal to impose a co-payment on Medicare home health services, the Home Care Alliance has issued a release to the press. Any home care agencies or concerned advocates is encouraged to follow up with local media and make the public aware of this proposal.

Below is the Home Care Alliance’s statement:

President Proposes Home Health Copays to Help Reduce Federal Deficit

Industry Calls Copayments an Inappropriate Burden and a Tax on Most Vulnerable Elders

Boston, MAWith the debate over the federal budget debt ceiling heating up, the Home Care Alliance of Massachusetts has joined organizations from across the nation in vehement opposition to President Barack Obama’s proposal to impose co-payments for Medicare Home Health Services.

What began as a recommendation to Congress by the Medicare Payment Advisory Committee (MEDPAC) is now entrenched in discussions over how the country will raise revenues and reduce spending.

“It has been shown in many studies that copayments are an inefficient and regressive ‘sick tax’ that falls most heavily on the poorest and oldest Medicare beneficiaries,” said Patricia M. Kelleher, the Executive Director of the Home Care Alliance of Massachusetts. 

Congress eliminated home health copayments in 1972 as part of a Medicare modernization effort that concluded that such copayments fell disproportionately on the home health users with the highest Medicare expenses and the worst health status. Moreover, they discouraged using home health in lieu of more expensive nursing facility stays. As recently as 2003, Congress rejected a home care co-pay proposal for the same reasons.

President Obama’s proposal calls for a copayment of $100 per Medicare episode and excludes Medicare episodes immediately following a hospital stay. The measure would only apply to new beneficiaries beginning in 2017 and is estimated to save approximately $400 million over 10 years.

“Imposing of a copayment would continue an assault on the Medicare home health benefit that witnessed $39.7 billion in cuts passed by Congress last year,” said Kelleher. “Additionally, on January 1, 2011, Medicare added a new impediment to accessing services by requiring that homebound elderly and disabled patients, as well as hospice patients, will now need to have a ‘face-to-face encounter’ with a physician or nurse practitioner in order to receive home health services under Medicare.”

Most home health users are age 75 or older and in very poor health.  A Commonwealth Fund Report recently found that individuals of all incomes with fair or poor health status or age 85 and older spent almost 30 percent of their income already on uncovered medical care, primarily due to Medicare gaps, deductibles and copayments. Additional publications, including the New England Journal of Medicine, have released findings that an increase in such copayments lowers utilization and increases hospitalizations.

“Home health agencies in Massachusetts have supported aggressive efforts to slow growth of home health spending, including testifying in support of a moratorium on new agencies,” said Kelleher. “Asking patients to pay more is not the answer.”   

Return to www.thinkhomecare.org.

Blue Cross AQC Contract Examined

An article in this week’s New England Journal of Medicine takes an interesting look at the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract in terms of its impact on cost and quality and lessons it may hold for broader attempts to move towards global payment, locally and nationally.

The report – Health Care Spending and Quality in Year 1 of the Alternative Quality Contract – was compiled by researchers at the Harvard Medical School, the Heller School and Boston University. According to the report the AQC contains three distinguishing features.  First, physician groups, in some cases together with a hospital, enter into 5-year global budget contracts (rather than standard 1-year contracts).   Second, AQC groups are eligible for pay-for-performance bonuses up to 10% of their budget, with performance measures of ambulatory care and hospital care each contributing to half of the calculation of the bonus. Third, AQC groups receive technical support from BCBS, including reports on spending, utilization, and quality, to assist them in managing their budget and improving quality.

At present, the authors report, there are 321 PCP practices and more than 4000 physicians in the AQC.   The very general findings:

  • AQC was associated with modestly lower medical spending and improved quality in the first year after implementation.
  •  AQC quality bonuses are much higher than those in most pay-for-performance programs in the United States, since they apply to the entire global budget rather than to physician services alone or PCP services alone.
  • Procedures, imaging, and testing accounted for more than 80% of the savings. Savings derived largely from less spending on facility services in the outpatient setting. There were no significant changes in spending for inpatient care or for physician services.

The question raised is: are savings at least for this non Medicare population more in “shifting outpatient care to providers who charged lower fees” than in behavior change?  If so, what lessens are here for broader global payment models, especially those that involve Medciare and Medicaid?


Alliance Comments on Proposed PPS Rule

The Home Care Alliance of Massachusetts today submitted comments to CMS on the proposed rule for Medicare home health PPS.  In our comments, we recommend that CMS rescind the across-the-board 5.06% case mix reduction and instead use its enforcement authority to identify and prosecute those few agencies that inflate their billings.  The Alliance urges CMS to conduct a comprehensive review of the case mix system, with involvement of home health industry experts.

Regarding the proposed wage index changes and in light of the new rural floor wage index for hospitals in Massachusetts, we urge CMS to establish a policy to set the wage index for home health agencies to be equal to the wage index of the largest hospital within each CBSA if that hospital has been re-classified to another CBSA or qualifies for the rural floor wage index.

The Alliance also urges CMS to waive the Face-to-Face documentation requirement for patients discharged from an acute or post-acute care setting within 14 days of the home health admission, and recommends that CMS provide additional clarification to the “confined to the home” definition (and provides clarification and guidance to Medicaid programs to reduce wasteful TPL initiatives that hinge on the definition.

Alliance member agencies are urged to use the Alliance’s comments as a model to submit their own comments on the www.regulations.gov website.