Author: James Fuccione

HCA Starts Congressional Letter on Home Care Moratorium

Thanks to the advocacy efforts of the Home Care Alliance and the cooperation of legislative home care champions, Congressmen Jim McGovern (D-MA) and Walter Jones (R-NC) are circulating a letter to be sent to federal Health and Human Services Secretary Kathleen Sebelius urging her agency to utilize the authority given in the Affordable Care Act to establish a temporary and targeted moratorium on new home health providers to control fraud and abuse in troubled areas.

Alliance staff drafted the letter, which is now a bipartisan effort that is seeking support from Congressional representatives from across the country. HCA has sent direct letters to Secretary Sebelius in the past and has supported drives by national associations towards getting a temporary and targeted moratorium established. The fact that the entire industry has been punished for the actions of a few agencies in a few areas of the US has driven the repeated attempts at lobbying HHS. This moratorium action certainly would not halt fraudulent and abusive practices, but it does help to contain the problem, especially in areas that have seen dramatic growth in the number of certified home health agencies.

The Alliance strongly encourages its members and supporters to contact their representative and urge them to sign on. Let your federal representative offices know that they should contact Congressman McGovern’s office to sign on.

Return to www.thinkhomecare.org.

Register for Great Events in October

October is a busy month for events at the Home Care Alliance with some unique opportunities to hear insight from state government on their activity around care transitions, hospice/palliative care initiatives, and electronic health record implementation. http://primagine.files.wordpress.com/2010/10/fall-leaves-1.png

The month kicks off with an Executive Breakfast with Madeleine Biondolillo, MD on October 4. Dr. Biondolillo  is the Director of the Mass DPH Bureau of Health Care Safety and Quality, which is responsible for such efforts as improving care transitions, implementing new End Of Life Care Initiatives, and establishing a health care workforce center.

The Alliance is also pleased to host a free event at the VNA of Boston on October 5th for home health IT personnel as well as other interested agency leaders and staff on the state’s “Last Mile” Implementation regarding electronic health records. This event will involve a presentation and discussion with Lawrence Stuntz who is the Director of the Massachusetts eHealth Institute, the Commonwealth’s entity for health care innovation, technology, and competitiveness. Although there is no cost, HCA is requiring registration.

To see our other events for this month, including informative webinars and meetings, check out HCA’s calendar of events.

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New Reports on Hospital Readmissions from STAAR and DHCFP

The Massachusetts State Action on Avoidable Readmission (STAAR) project has published a new report on the Patient Care Link website. The report – Reducing Readmissions: Highlights from the Massachusetts STAAR Cross Continuum Teams  – includes improvement stories from 22 of the 50 cross continuum teams working on reducing readmission.

Available on the Preventing Avoidable Readmissions page of the MA Coalition to Prevent Medical Errors website is a digest of customizable tools that eleven of the teams have made available free of charge. The STAAR work and these reports were funded by a grant from the Commonwealth Fund.

Also available from the state’s Division of Healthcare Finance & Policy (DHCFP) is a pair of new health care cost trend reports that conclude preventable hospitalizations have slowed, although preventable emergency department use has slightly risen.

The first report states that preventable hospitalizations are not driving cost growth, but remains a significant percentage of overall health care expenditures. Some of the more notable findings indicate that nearly half of preventable hospital admissions are for people aged 75 and older and 64 percent are for those over 65 years of age.

The report suggests something of no surprise to home care agencies, which is that managing chronic illnesses between non-acute health care settings is the best approach to combating the issue. However, the report further states the fee-for-service pay structure remains a barrier to that method working efficiently. Demographic influences aside from age were also noted as those lower income and some minority groups were more likely to receive costly and inefficient care that led to a higher rate of preventable hospitalizations among those groups.

As for the DHCFP report on hospital emergency department efficiency, the number of preventable ED visits rose 6.3 percent from 2006 to 2010 to a total of more than 1.17 million. Preventable or avoidable visits, the report continues, accounted for more than 45 percent of total ED visit costs.

To see both DHCFP reports, visit their  Cost Trends page.

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Mass. Thanks HCA and Members for Survey Participation

The state’s Executive Office of Health and Human Services thanked the Home Care Alliance and member agencies who participated in the recently completed Direct Service Workers (DSW) Survey.

A comprehensive report of the survey results is underway and those results will be available Fall 2012. Results will be shared with all providers who received the survey. Below is part of the ‘thank you’ statement:

Thanks in large part to outreach assistance provided by Home Care Alliance of Massachusetts, we received a survey response rate of 36%.  We’re happy to announce that the federal contractor, The Lewin Group, who has provided assistance through the survey process, is preparing a report which will include an analysis of the Massachusetts survey results. The Lewin Group anticipates this report will be ready for distribution by the end of September and we plan to share the report, along with additional survey results and analysis, with all providers who received the DSW Employer Survey.  We will distribute the report by email and will send a postcard to all providers asking them to submit an email address for this purpose.

The Direct Service Worker Employer Survey is a collaborative effort with the Home Care Alliance of Massachusetts and Massachusetts Council for Home Care Aide Services, Inc. to collect state-specific data on the home and community-based direct service workforce including volume, stability, wages and compensation.

According to EOHHS, information from this survey will be used to develop ways to attract more workers and keep workers longer.  The information from this survey can also assist organizations in understanding how they compare to other organizations in Massachusetts, and how organizations in Massachusetts compare to those in other states. Survey results will be used to better understand the current state of the direct service workforce in Massachusetts and areas for policy improvement.

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Last Chance to Apply for CMS Community-Based Care Transitions Program

The final deadline for applications for the Community Based Care Transitions Program, administered by the Center for Medicare and Medicaid Innovation (CMMI), is quickly approaching.

Any interested applicants must have their proposals in by September 3rd to make the final panel review on September 20th. Any interested home health agencies can contact James Fuccione at the Home Care Alliance for assistance. Additionally, CMMI has made a slide deck available with everything health care providers and community-based organizations need to know for the application process.

Recently, there were 17 proposals that were accepted in the third round of site selections and, again, a Massachusetts project was among them. Here is the “site summary:”

Somerville-Cambridge Elder Services, a Massachusetts-designated Aging Services Access Point (ASAP) and an Area Agency on Aging (AAA), is partnering with Mystic Valley Elder Services,  two large integrated hospital networks (Cambridge Health Alliance and Hallmark Health System) and dozens of community-based health and social service providers to provide care transitions services to high-risk Medicare beneficiaries throughout Middlesex County, Massachusetts.

For more on HCA’s work on care transitions issues, see these blog posts.

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HCA Continues Response to Home Care Aide Report

Picking up on news stories developed by the New England Center for Investigative Reporting,  WCVB-TV in Boston plans to run a television story on the private pay home care industry, with an expected focus on the state’s lack of licensure of agencies.    While both the New England Center and WCVB have been looking for cases of private care elder mistreatment, both stories appear focused on a single case of an aide who stole from multiple clients before being charged and convicted in both the Brockton and Wareham District Courts.

Alliance Executive Director Patricia Kelleher was interviewed by WCVB for the news story.  During the interview, Ms. Kelleher emphasized the following points:

  • While no abuse is to be tolerated, instances of theft or abuse are very rare given the thousands of clients and million of visits in a given year.
  • The Alliance had filed licensure legislation in 2010 that was not passed.
  • In response to no legislative action, the Alliance and its private care members developed a rigorous industry accreditation program that establishes high standards for worker screening and training, organizational management and workforce safety.
  • Prospective clients in Massachusetts are fortunate to have a robust industry with many options to choose from.  Educated consumers are our best clients.

The Home Care Alliance has also placed letters to the editor in two major Massachusetts daily newspapers to clarify some points in the story. See HCA’s letters in the Worcester Telegram & Gazette and the Springfield Republican.

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‘Home Care Votes’ Program is Back

With the deadline to register to vote rapidly approaching on August 17, the state primary election just around the corner (September 6), and the state’s general elections not far past that (November 6), the Home Care Alliance is encouraging its member agencies across the state to help “get out the vote.”  

The Alliance has a fact sheet with instructions and a sample press release (available upon request) for those agencies willing and interested in helping their homebound patients obtain absentee ballots so they can vote in the upcoming elections. With important policy issues looming, this program is a great way to mobilize a population that may not otherwise have the chance to have their voices heard.

For those interested in obtaining the sample press release, contact James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

HCA Responds to Questionable Northwestern U Study on Private Pay Home Care

The Home Care Alliance has responded to a Northwestern University report, titled “Hiring and Screening Practices of Agencies Supplying Paid Caregivers to Older Adults” that confuses different models of private pay home care and asserts that most aides are not properly screened or trained.  The report, from researchers at the NU Feinberg School of Medicine, appeared in the most recent issue of the Journal of the American Geriatrics Society.

The study authors telephoned agencies in Illinois, California, Florida, Colorado, Arizona, Wisconsin, and Indiana, pretending to be looking for home care for a family member.   The information provided by the agencies over the telephone was analyzed and some broad and negative conclusions were drawn about the lack of industry standard practices for background checks, training requirements, and supervision. The report was discussed this week in the New York Time’s “New, Old Age” blog in a post called “Who’s Watching Mom?”

Please see the Home Care Alliance’s response to this report and feel free to use this in the event that your agency receive media inquiries.

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Request for Responses for Consumer Consultants

MassHealth released an RFR to recruit “consumer consultants” that will assist with the review of applications from potential Integrated Care Organizations managing care for dual eligible individuals.

The demonstration project to better integrate and coordinate care for dual eligibles is still set to begin in January 2013 and the state remains on an aggressive pace to get the initiative underway. The RFR for Integrated Care Organizations (ICO’s) is due at the end of the month, and this separate RFR for “consumer consultants” is due July 20th.

These “consumers” must receive medical services, behavioral health services and/or long term services and supports (LTSS) from the state and will form a paid advisory subcommittee that shares its experiences and expertise with MassHealth and the state’s Executive Office of Health and Human Services.

The RFR is available on the state procurement website Comm-PASS as Document Number 13CBEHSCONSUMERCONSULTANTRFR and at this site on the Integrating Medicare and Medicaid for Dual Eligibles website under Related Information.

For those home care agencies that have patients with positive experiences of the care and services that have been delivered to them and that may be interested, please encourage them to apply.

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Home Care Alliance, National Organizations Make Statements on Supreme Court Decision

In light of the Supreme Court’s decision to uphold the Affordable Care Act, the Home Care Alliance of Massachusetts and other organizations representing health care providers and consumers had this to say:

“Today’s decision of the US Supreme Court has established the Affordable Care Act as the law. With their ruling, the Supreme Court has removed enormous uncertainty – particularly in states other than Massachusetts and for those involved in ACA funded demonstrations – as to whether to move forward. They now can, and we think they must.  While some parts of the law will impact Massachusetts far less directly than other states, there is evidence that our state has already benefited by some provisions. Most notably, 62,000 seniors and people with disabilities in Massachusetts have seen significant savings on their prescription drugs because the law was upheld.

All providers, including home health care, were subject to Medicare rate reductions in the ACA in order to expand coverage and pay for reform demonstrations.  These cuts have not been easy to absorb. With this ruling, we must now get to work to deliver on the promise in our state not just of universal access to insurance, but to a better coordinated, and ultimately more cost effective delivery system.”

-Patricia Kelleher, HCA Executive Director

Statement from the National Association for Home Care & Hospice (NAHC):

“NAHC has long supported reforms that increase access to health care for all in the United States and supports health delivery reforms and the expansion of Medicaid eligibility. The ACA rightly shifts the focus of care from inpatient services and institutional care to the community setting, which home health agencies and hospices have effectively served for decades.

NAHC believes that the Affordable Care Act can and should be improved. Accordingly, NAHC will continue to work with both Democrats and Republicans to improve the legislation. NAHC will ask that its implementation date be delayed for two years so that states have the time to prepare for implementation, including the creation of exchanges. This delay will also save approximately $200 billion, which can be applied to deficit reduction, extending the SGR “doc fix” and avoiding the need for any further cuts to Medicare. NAHC will continue to argue that home health care has been cut disproportionately and will oppose the imposition of copayments or additional cuts. NAHC believes that a good case can be made for expanding the scope of Medicare home health services to reduce hospitalization costs and improve services for the 5 percent of Americans who are responsible for 50 percent of total U.S. health care costs.”

-Val Halamandaris, NAHC President

Here are other statements from the following organizations:

And statements from political leaders:

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