As 2013 comes to a close, the Home Care Alliance looks back on the year in home care news. The Jimmo case, Boston Marathon Bombing, and the shutdown of the federal government all were stories that had an enormous impact on home care agencies and made some people realize the importance of home care services. Other stories more specific to the industry like Medicare “rebasing” cuts and HCA’s policy victory of getting state-based reimbursement for home telemonitoring reflect the ongoing work needed to push decision-makers on what home care can do for people.
See the top home care news of 2013 and let us know what you think in the comments section!
On January 24, 2013, the Chief Judge of Vermont’s U.S. District Court gave her approval during a scheduled fairness hearing for an ‘improvement standard’ settlement (Jimmo v. Sebelius). This settlement could lead to more long-term care in the home health setting and open the benefit to patients who were previously denied coverage….
By Laurance Stuntz, Director at the Massachusetts e-Health Institute (MeHI)
Care Providers: Make your voice heard! Participate in MeHI’s Health IT Research Study
Here at the Massachusetts eHealth Institute (MeHI), we have been busy traveling across the state to meet with healthcare providers, listen to their concerns, and share many of the programs our organization is undertaking to help with health IT adoption in the Bay State.
Our series of regional meetings have continued this fall, and have been very well attended from many healthcare segments including home care. These events have provided a great forum for providers and their organization’s leaders to ask questions about what’s ahead for health IT and how it will affect their particular area of specialty in the patient care continuum. In addition, we have been speaking at important local home care events including the Home Care Alliance Financial Management Conference.
With all of this activity and interest, we recognize that providers have a wide range of attitudes, opinions and needs regarding health IT adoption. We know there is much more work to be done and we want to partner with you to develop new strategies and programs to support complete EHR and Health Information Exchange adoption across the state, including ongoing improvement of the overall effectiveness of use of EHRs. It’s vital that you and your colleagues have a seat at the table.
This is why MeHI is undertaking a Provider and Consumer Research Study. This effort is aimed at gathering comprehensive information on the use, needs and attitudes toward health IT among both providers and consumers.
The research firm Market Decisions will be contacting thousands of health care providers and hundreds of consumers across Massachusetts to speak with them about health IT. The research will help identify specific challenges with health IT adoption and provide us with valuable insights.
If you are contacted, we encourage you to take 5 to 10 minutes to speak with the Market Decisions representatives to provide your perspective about the use of health IT in Massachusetts, including what you see as the major challenges in adopting these technologies. If you would like to take the survey now, please follow the link below to participate. We want your input!
We hope that you will take the time to participate in this important survey. We are confident the first-hand perspectives we collect will lead to the development of thoughtful, well-informed strategies for providing the best health IT support and services to providers, as well as an improved healthcare experience for patients.
Laurance Stuntz is a Director at MeHI, a division of the Massachusetts Technology Collaborative. MeHI was empowered by the Massachusetts legislature to expand the adoption of eHealth technologies and further innovation in health IT across the Commonwealth. Follow Laurance on Twitter at @lstuntz
The Home Care Alliance’s annual Financial Managers Conference was held last week at the Conference Center at Waltham Woods. The conference included presentations on benchmarking and operational efficiencies (from principals from BKD and McBee Associates), as well as a presentation from Emily Brower, the Director of ACO programs at Atrius Health. Atrius Health is one of five Pioneer ACOs in Eastern MA. Ms Brower’s presentation was summarized in Home Health Technology Report by Tim Rowan, who was also at the conference to present on IT Trends.
Ms Brower talked frankly about their need to manage costs, their dependence on their home care agency VNA Care Network/VNA of Boston and their progress in creating truly integrated plans of care. Read Tim Rowan’s summary here.
The National Association for Home Care & Hospice (NAHC) held a conference call revealing a frantic final week of advocacy activity before Congress takes its holiday recess until the New Year.
The major part of that activity for home health agencies centered around the attempt to delay the impacts of Medicare “rebasing” cuts through an amendment to the Medicare Sustainable Growth Rate (SGR) fix – also known as the physician fix.
Senator Debbie Stabenow (D-MI) offered an amendment on behalf of home care that would delay the cuts for one full year and give the industry the chance to lobby CMS to change their methodology with more updated and accurate data. Unfortunately, part of the compromise of the short -term physician fix was that it was a “clean” bill, which means no outside amendments. According to NAHC, even the hospital industry had amendments that were proposed and then withdrawn because of that agreement between Democrats and Republicans.
The short-term SGR fix will last for three months and must be offset by $7 billion. The good news there is that none of the offset is coming from the home health industry. Some of the hit is being hit is being absorbed by cuts to Long Term Care Hospitals and Disproportionate Share Hospital rates, but copays and additional reductions for home care were avoided.
The light at the end of the tunnel comes from the fact that the Senate is working on a permanent SGR fix and the Stabenow amendment will still be in play for that effort. In addition, NAHC was successful in getting language from the FITT Act into the Senate’s proposal. The FITT Act essentially establishes a national pilot program for home-based telemonitoring provided by home health agencies. It will not be straight reimbursement, but is meant to be a shared savings approach where the providers and Medicare will share in any efficiencies gained. Moreover, if the program is successful, NAHC indicated that the program could be expanded by Medicare without going back to Congress for approval since it is a pilot and not a demonstration.
In terms of hospice care, NAHC also reported that another amendment would allow physician’s assistants to serve as the attending physician for hospice patients.
All of these wheels will be in motion in the New Year, but the main idea is that Democrats and Republicans compromised on a two-year deal that keeps the federal government running and it was done without implementing co-payments for home care. The 2% sequester cuts are extended for an additional two years, but those are not “new” cuts and are simply to make the budget scoring work. By the time the extended years are reached, the sequester could potentially be a thing of the past.
The Home Care Alliance thanks agencies for sending nearly 200 messages to the Massachusetts Congressional Delegation in two days. That education and advocacy will be critical as we move forward to fight rebasing in the New Year. Of course, further information will be provided as it becomes available.
Congress is working in the final days before the holiday recess on a long-term Medicare Sustainable Growth Rate (SGR) process and an amendment to that process could delay the impending rebasing cut to home health care.
Senator Debbie Stabenow (D-MI) has offered an amendment that essentially delays the effects of rebasing so that CMS can hopefully adjust their methodology with updated and more accurate data. Educating the Massachusetts Congressional Delegation is crucial to getting support for the amendment as there is so much happening in the final two days of activity.
More information and a prepared email message is available on HCA’s Legislative Action Network and it only takes a minute to log on and add your voice to this critical push to delay a damaging 3.5% cut per year over the next four years.
We also urge members to call the offices of your Congressional representatives directly using the message below as a guide. Simply call the main switchboard at (202) 224-3121, request a transfer to the office of your Congressional representative, and ask to speak to the individual from that office that is responsible for health policy.Here is the text of the message to Congress if you choose to call:
The U.S. Centers for Medicare and Medicaid Services (CMS) has finalized a rule imposing unprecedented Medicare home health reductions under a process called “rebasing.” All told, the impact on providers will be a $200 million cut in each of the next four years.
We are asking for your support in backing an amendment from Senator Debbie Stabenow as well as any corresponding effort in the House to amend the Medicare Sustainable Growth Rate (SGR) process.
These are the largest cuts to home health in decades, and they will cause many agencies to close their doors, especially if these cuts are compounded by Medicare reductions via the continuing budget resolution. Such cuts are counter-productive at a time when health reform relies on cost-effective care at home to serve vulnerable citizens.
CMS’s rebasing cuts were finalized on November 22 and go into effect on January 1. This leaves little time to delay these disastrous cuts and compel CMS to conduct a more fair, accurate and thorough analysis of its fiscal assumptions.
The data is clear. Many Medicare-certified home care providers are already operating in the red across all sources of payment. These new cuts – scheduled to be compounded for each of the next four years – will cripple the industry and create barriers to care. Yet, despite similar trends across the country, CMS concludes that draconian rebasing reductions are needed to eliminate positive margins in home health. CMS’s math simply does not add up.
Many in Congress agree. A bipartisan letter sent to CMS raised strong concerns, stating that the rebasing methodology relies on “incomplete data and analysis that results in the under-counting of home health agencies’ costs per episode of care, and an inappropriately high rebasing adjustment.”
Home care providers nationwide thank you and your colleagues in Congress for your strong stance on rebasing and we ask for your continued active engagement supporting Senator Stabenow and others to delay rebasing and initiate a more rational approach from CMS.
Several healthcare industry news outlets, including Modern Healthcare, are reporting that CMS is extending the deadline that providers are required to show Stage 2 “Meaningful Use” criteria of electronic health records (EMR).
The overall deadline is delayed for one full year and, according to Modern Healthcare, Stage 2 of the CMS incentive program to encourage EMR adoption will be extended through 2016. Stage 3 won’t begin until at least fiscal year 2017 for hospitals and calendar year 2017 for physicians and other eligible professionals that have by then completed at least two years at Stage 2.
CMS and the Office of the National Coordinator for Health Information Technology at HHS say that the delay is intended help both federal entities focus on helping providers meet Stage 2’s demands for patient engagement, interoperability and information exchange, as well as use data collected during that phase to inform policy decisions for Stage 3.
The proposed rules relative to the requirements providers must meet for Stage 3, as well as the 2017 Edition of standards that health IT developers must build and test their systems to match, are expected to be released in the fall of 2014 .
The Modern Healthcare article noted that the program, created under the America Recovery and Reinvestment Act of 2009, has paid out about $17 billion since January 2011, according to the latest CMS data.
Earlier this year, the Alliance published twobrochures regarding patient choice after a hospitalization or stay in other medical facilities.
We’re pleased to announce the publication of a Spanish translation of the patient-orientated version, “Your Care, Your Choice,” which reminds patients of their right to choose their own providers, and empowers them to report facilities that attempt to violate these rights.