Following a public hearing and a request for feedback, the Home Care Alliance submitted comments on proposed standards for physician practices seeking designation as Patient-Centered Medical Homes (PCMH).
The state’s Health Policy Commission (HPC), created in the state’s Health Care Cost Containment Law, is charged with developing and implementing standards of certification for PCMH in the Commonwealth and will be working to finalize the proposed criteria in the coming months.
The Alliance’s comments promoted the potential of partnerships with home care agencies based on their ability to help physician practices meet some of the proposed standards. The Alliance specifically suggested that PCMH certification require that physician practices meaningfully partner with at least two agencies for the lowest tier of the designation with higher numbers of partnerships in higher tiers. The HPC currently has Basic, Advanced, and Optimal levels of PCMH certification, which may change in name.
The purpose of the certification process is to complement existing local and national care transformation and payment reform efforts, validate value-based care, and promote investments by payers in efficient, high-quality and cost effective primary care.
Although Home Care Alliance staff will be advocating for home health care in Washington DC on March 24-26, the HCA is still stepping up with support for an Elder Lobby Day at the State House on Monday, March 24th.
The Alliance is a sponsor for the event and will be well represented with Bayada Home Health Care, Associated Home Care and other agencies joining the following organizations and their representatives:
Mass Home Care
The Caring Force
Home Care Aide Council
AARP Massachusetts
Mass Senior Action Council
Mass Councils On Aging
Mass Human Services Provider’s Council
Mass Association of Older Americans
LGBT Aging Project
Jewish Community Relations Council of Greater Boston
A speaking program will take place between 11:00am and 2:00pm on March 24th at the Grand Staircase (second floor of the State House). Afterwards, attendees will be stopping by legislative offices to drop off information about their organizations and to advocate on elder policy issues.
For more information on the event, contact James Fuccione at the Alliance.
The Home Care Alliance is hosting the annual Home Care Innovation Showcase and STAR Awards on April 29th at the John F. Kennedy Presidential Library and Museum. Among those the Alliance recognizes is a “Physician of the Year,” which is nominated by an agency or community partner and awarded to a physician or nurse practitioner who has demonstrated:
Active involvement in the homehealth field,
Outspoken support for health care delivered in the home; and
Longevity in the home health profession
Last year’s Physician of Year award winner was Dr. James Everett who is Medical Director for Hospice of the South Shore. He was nominated by the Hospice’s Director Barbara Karkos who lauded Dr. Everett’s collaborative nature.
HCA’s 2013 Physician of the Year, Dr. James Everett
“Dr. Everett consistently combines compassion with clinical expertise, always working with us to ‘do the right thing’ for each patient and family,” said Karkos of Dr. Everrett. “He demonstrates true partnership in all of his interactions with the staff at Hospice, as well as with his colleagues in the community, and with patients and families he visits in the home.”
Karkos also touted Dr. Everett’s ability to be innovative in embracing new technology and improving processes, especially when it came to the “physician face-to-face” requirement.
The Home Care Alliance knows there are many “Dr. Everetts” out there and look forward to awarding the next Home Care Physician of the Year.
The Massachusetts One Care Initiative, which aims to better coordinate care and services for dually eligible individuals ages 21-64, officially launched the One Care Ombudsman program (OCO). Home health agencies involved in One Care should be aware of this new resource.
According to a notice sent by the state, the OCO:
Is an independent program operated by the Disability Policy Consortium (contracted by EOHHS) and its partners, Health Care For All (HCFA) and Consumer Quality Initiatives (CQI);
Addresses concerns and helps resolve conflicts regarding members’ enrollment in One Care or access to covered benefits and services so they can receive the benefits and exercise the rights they are entitled to in One Care; and
Works with members and their representatives, as well as MassHealth and the three One Care plans, to find resolutions to members’ concerns or complaints.
The OCO does not duplicate or replace other resources that are already available to help people with One Care (such as the SHINE program, the One Care plans’ member services, and MassHealth Customer Service). The OCO is an additional resource to support members who need or request independent problem-resolution assistance beyond what is available now. The OCO provides three main types of services: Continue reading “One Care Initiative Launches Ombudsman Program”
The Bundled Payments for Care Improvement initiative, developed by the Center for Medicare and Medicaid Innovation, has been reopened for additional models focusing on post-acute.
Through the initiative, organizations partner together and enter into payment arrangements that include financial and performance accountability for episodes of care. There four models of bundled payment being tested, but models 2 and 3 are areas where home health agencies can play a central role.
Model 2 is titled Retrospective Acute Care Hospital Stay plus Post-Acute Care, where the episode of care includes the inpatient stay in the acute care hospital and all related services during the episode.
Model 3 is Retrospective Post-Acute Care Only, where the episode of care is triggered by an acute care hospital stay and begins at initiation of post-acute care services with a participating home health agency, skilled nursing facility, inpatient rehabilitation facility, long-term care hospital.
More information on the program and the “open period” where new proposals can be submitted is available here. In order to be considered for participation in the Bundled Payments for Care Improvement initiative, all open period submissions must be submitted by April 18, 2014.
Despite having his state of the Commonwealth address delayed by a snowstorm, Governor Deval Patrick was required to release his budget proposal this past Wednesday to officially kick off budget deliberations for fiscal year 2015.
A huge win for elder home care services came in line items that support the Aging Service Access Points and state Home Care Program, which received an additional $16.9 million, according to Executive Office of Elder Affairs Secretary Ann Hartstein. Among those funds are increases of $9.8 million for the Enhanced Community Options Program (ECOP) and $7.5 million for the “basic” category of services.
Combined, according to Secretary Hartstein, those two line item increases will eliminate waiting lists through the end of fiscal year 2015. The funding boost works out to an additional hour of homemaking services per consumer per month on average, but Secretary Hartstein stressed that, in reality, the money would pay for whatever services people may need when they need them.
The Governor also put a $1.3 million increase to the Senior Supportive Housing account, which will expand “assisted living facility-type services” for seniors in public housing. Specifically, the money will add another 10 public housing sites where senior residents will be supported by home care services.
Another $1.2 million was added in a new line item titled “Home Care Workforce Training Fund.” This new account will support workforce training for Aging Service Access Points, although the administration is not yet clear on which workers will receive training. Case management, protective services and direct care workers are all on the table as potential recipients.
MassHealth experienced major changes in the budget, mostly related to federal healthcare reform. Since the MassHealth Basic and Essential programs were eliminated, a combined $706.3 million is now in populations with expanded coverage and in the new MassHealth plans. The MassHealth Senior Care account was granted another $271.4 million by the Governor and the MassHealth Managed Care account saw an additional $336.7 million. The MassHealth Fee-for-Service line item was raised by $205 million. It is unclear how these increases might result in better reimbursement rates for home health agencies. A formal rate reassessment hearing is still being eagerly awaited.
Other items of note from the Governor’s budget include the following:
Applying the state sales tax to candy and soda. The administration estimates that would raise roughly $57 million for health promotion and prevention programs.
The Governor’s budget cuts the MassHealth Nursing Home Supplimental Rates by $20.7 million
Pediatric Palliative Care is essentially level funded at just over $1.5 million
The Governor’s budget includes a special fund for federal assistance (FMAP) relative to health reform and healthcare access expansion called the Health Insurance Expansion Fund.
Once again, the actions of the few bad actors in home health and hospice are getting media attention rather than the vast majority of agencies that are devoted to providing high quality care to keep people comfortable and at home.
In an investigative report, the Washington Post highlights findings that the number of patients discharged alive from hospice rose by 50 percent between 2002 and 2012. The article also highlights numbers from the Medicare Payment Advisory Commission (MedPAC) stating that in 2011, nearly 60 percent of Medicare’s hospice expenditure of $13.8 billion went toward patients who stay on hospice care longer than six months. The article singles out for-profit hospices in particular, but still puts all hospices in a negative context.
We must all do our part to ensure that hospice remains a viable choice for terminally ill patients and their loved ones. Articles of this type may unwittingly discourage use of hospice care, thereby denying terminally ill patients and their families access to vital services that support and comfort them during and in the aftermath of one of life’s most difficult journeys. Under these circumstances, no one is well served.
What’s happening here? Hospices have lamented for years that dying patients wait too long to call, enrolling at the eleventh hour when they could have benefited months earlier. Now, we’re hearing more about patients doing as hospice believers (including me) have urged, calling earlier in the course of a terminal disease — and then, in a substantial minority of cases, getting bounced.
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….
On January 31, 2013, Massachusetts will become the second state to require staffing agencies to provide basic job information to employees assigned to temporary or part-time jobs. An Act Establishing a Temporary Worker’s Right to Know will amend Massachusetts General Law, chapter 149, section 159C. The following article provides an overview of the substance of the law and how to comply….
By Laurance Stuntz, Director at the Massachusetts e-Health Institute (MeHI)
Click the image to complete survey!
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 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.
Among those funds are increases of $9.8 million for the Enhanced Community Options Program (ECOP) and $7.5 million for the “basic” category of services.
Think Home Care Blog 