Author: James Fuccione

Boston Globe Op-Ed: Finally, Long-Term Home Health Care

Former Boston Globe editorial pages editor and current Senior Fellow at the Harvard AIDS Initiative Loretta McLaughlin wrote about US Senator Ted Kennedy’s effort to include home health in the national reform initiative.

The Op-Ed piece from July 19 highlights Senator Kennedy’s proposal, the associated costs, and how it would work. Click here to read “Finally, long-term home health care.”

McLaughlin writes how the need for home care is immense as is the proper coverage to help people pay for it. She states:

More than 10 million Americans receive home care, and the number will rise rapidly as the population ages. Estimates hold that 75 percent of us will need home care at some point during our lifetime.

This kind of medical/social service is of inestimable benefit to the chronically ill, the elderly, the mentally disabled, and to adults recuperating from a temporary illness. Home-based personal assistance would allow many of them to return to work. And it would be a godsend for the 90 percent of Americans who have had no meaningful protection against this medical expense.

Return to www.thinkhomecare.org.

Letter to MA Congressman: Stop Cuts to Home Care

Three committees in the US House of Representatives – House Ways & Means, House Energy and Commerce, and House Committee on Energy and Labor, each with their own subcommittee on health – have jointly submitted a health care reform proposal known as the Tri-Committee Health Reform Bill.

The legislation includes the Medicare Payment Advisory Commission’s (MedPAC) recommendations that Congress eliminate the home health market basket update for 2010 and accelerate the application of the 2011 coding creep adjustment proposed for 2011 (2.71 percent) to 2010 – reducing current rates in 2010 by 5.46 percent. MedPAC also recommended that Congress direct CMS to rebase home health payments in 2011, using 2007 costs as a base.

this effort would bring devastating cuts, which over ten years would take $51 billion from the Medicare home health program, according to the Congressional Budget Office (CBO).

Recently, the Alliance’s Executive Director Pat Kelleher and Board President Patricia O’Brien sent a letter (see below) to Massachusetts Congressmen highlighting our major concern over this proposal. Please help us advocate by clicking here and sending an email message to YOUR Congressional representative (see first message under “Federal or National Issues”).

Dear Congressman:

On behalf of the 150 home care agencies that comprise the Home Care Alliance of Massachusetts,  I write to express our strong concerns with provisions in the U.S. House of Representatives’ “Tri-Committee Health Reform Proposal,” which calls for catastrophic cuts to the Medicare home health program.

It is estimated that the House proposal would cut home health Medicare payments by $51 billion over ten years.  The proposal would eliminate the home health market basket update for 2010 and accelerate the application of the payment adjustment proposed for 2011 (2.71 percent) to 2010—reducing current rates in 2010 by 5.46 percent.   For Massachusetts, this means that Medicare home health reimbursement would be reduced by more than $16 million in the next year alone and more than $300 million over the next five years.

Cuts of this magnitude would deal a devastating blow to Massachusetts home health care.  Massachusetts home health agencies have seen almost no or miniscule increases in our Medicare payments over the last seven years.  Many home health agencies are already in financial jeopardy as a result of Medicaid cuts and inadequate Medicare Advantage payments.

Using cost report data from 2008, we have estimated that should these reductions be sustained, half of the home health agencies in Massachusetts, including virtually all of our safety net VNA’s, would have negative operating margins in FY 2010.

The recommendations for home health cuts come from MEDPAC studies that do not reflect what is happening in your district. These studies use a weighted average, combining all home health agencies into a single unit, rather than recognizing the individual existence and local nature of each provider. MEDPAC’s recommendations also fail to evaluate the impact of the completely reformed – and reduced – home health payment model put in place in 2008.

The Home Care Alliance supports health care reform and coverage expansion that is based on sound health care policy principles and builds on the strengths of our current system.  In supporting our call for reversing this cut, we call your attention to a study by Avalere Health (May 11, 2009: see attached) that found home health use saves Medicare dollars by reducing hospitalizations and nursing home stays.  Based on the findings in this study, an estimated $30 billion could be saved over the next ten years by expanding access to home health for chronic disease patients.

An underfunded home health system would hurt the most vulnerable elders in your district and will cause a ripple effect in the rest of the system backing people up in hospitals and costing Medicare and the taxpayers more money (After the Balanced Budget Act of 1997 cut billions from the Medicare home health benefit, Medicare expenditures on skilled nursing facilities and hospitals skyrocketed).

The Home Care Alliance is aware of the pressure on the current Medicare program to find efficiencies that can support expanded insurance access.   Our member agencies have supported efforts – endorsed by the National Association for Home Care – that would

·         Enact a moratorium on new certifications of Medicare participating home health agencies. Most of the questionable growth in home health expenditures has occurred in states with a saturation of home health agencies. For example, Texas has had a 200% increase in spending following a 100% increase in HHAs. In Houston alone, there are more HHAS than in New York, New Jersey, Pennsylvania, and Maryland combined

·         Institute a revenue-based provider-specific cap on outlier payments prohibiting outlier payment on a set percentage of an HHA’s Medicare home health revenue in a calendar year.   There is strong evidence that a minority of home health agencies are abusing the outlier payment system. While small in numbers, these providers have taken well in excess of $1B in outlier payments from the total of $16B in annual home health expenditures

The potential savings through this proposal are $4-8B over 5 years/ $16-23B over 10 years.

We appreciate your support for our agencies and the frail elders that are the beneficiaries of our services.

Return to www.thinkhomecare.org.

Boston.com: Home Care Champion

Boston.com ran a July 13 news blurb on Robert Dwyer, a 15-year Board Treasurer for the Norwell VNA and Hospice, who was given the “Home Care Champion” award by the Home Care Alliance at our annual conference.

Click here to see the article on Mr. Dwyer, who was one of four individuals honored by the Alliance.

Return to www.thinkhomecare.org.

Letter sent to state legislators citing physician survey

The Alliance sent an email to all state legislators announcing the results of a survey of Massachusetts physicians who overwhelmingly believe that home health provides multiple advantages to improving care and reducing costs without compromising outcomes.

The survey was conducted by the Massachusetts Medical Society in collaboration with the Home Care Alliance and represents one of the few efforts to learn more about the under-examined area of physician use of home health services such as skilled nursing care, physical and occupational therapy, speech-language therapy, and medical social services provided in the home.

The email to state lawmakers briefly summarized the results while drawing special attention to the barriers physicians noted get in the way of accessing home health services for their patients. The message to legislators also asks that, as the state looks to contain costs, home health is given the attention it deserves within the Massachusetts healthcare system.

See the letter text below:

Recently, an important healthcare study was completed that demonstrates how Massachusetts patients and their families, as well as taxpayers, can save money. The survey, which was conducted by the Massachusetts Medical Society in collaboration with our organization, the Home Care Alliance of Massachusetts, analyzed physicians’ attitudes and utilization of home health care services.

The results of the survey, enclosed for your convenience, represent one of the few efforts to learn more about the under-examined area of physician use of home health services such as skilled nursing care, physical and occupational therapy, speech-language therapy, and medical social services provided in the home. In addition to some important findings concerning caregiver stress, disparities in home health utilization between primary care doctors and specialists, and support for telehealth, the survey also found that:

  • Nearly 90 percent of responding physicians believe home health services can reduce inpatient hospital admissions,
  • 63 percent say home health care can reduce emergency room visits,
  • 78 percent reported better patient compliance with care plans, and
  • 97 percent say home health services help them better manage their patients’ care at home.

I invite you to review the enclosed materials, as well as a NECN story on the study results. I would like to draw your attention to the barriers mentioned in the results as well. Home health care saves money by keeping patients out of the hospital, emergency room and nursing home, yet 53 percent of physicians reported they had to prolong a patient’s stay due to lack of access to services. As the state looks to contain health care costs wherever possible, our hope is that you ensure home health plays a prominent role in the Commonwealth’s health care system.

Please do not hesitate to contact me with any questions or to request more information. To find home care providers in your district, you can visit our website, www.thinkhomecare.org.

Return to www.thinkhomecare.org.

White Coat Notes: MA doctors value home health services, note barriers

White Coat Notes is a blog on Boston.com that touts news from the Boston area medical community, covering a range of health-related topics.  In a July 6 entry, White Coat Notes covered the recently released survey conducted by the Massachusetts Medical Society in collaboration with the Home Care Alliance of Massachusetts physicians’ attitudes and utilization of home health services.

Click here to see the blog/article on the survey results.

Within the survey, there were multiple advantages in terms of improving care and reducing costs without compromising outcomes, but many barriers to accessing home health services were identified. Some of the more noteworthy results of the survey are below:

Positives:
•    97% say the services help them better manage their patients’ care at home
•    89% believe they reduce inpatient hospital admissions without compromising quality of care or health care outcomes
•    78% reported better patient compliance with care plans
•    78% believe telemonitoring services and remote monitoring of vital signs can improve quality of care; 67% believe these services can reduce patient cost
•    78% reported that past experience with a home care agency increased their confidence in referring patients
•    73% say services can reduce caregiver stress
•    65% reported better coordination of care plans
•    63% say they can lead to reductions in emergency department visits
•    50% reported faster recovery in post-acute care
•    41% believe they can provide cost savings

Negatives:
•    54% believed administrative burdens in the form of paperwork are the main barrier their use of home care services
•    53% reported they had to prolong a patient’s stay due to lack of access to services
•    40% noted that reimbursement issues were a barrier to using the services, yet 71% say they do not apply for reimbursement and 64% say they are unaware reimbursement is available.

Check out the full results of the physician survey here.

Return to www.thinkhomecare.org.

Boston Globe: Caring is Her Calling

Tama Lewis, a home health aide for Visiting Angels of Newton, was featured in a Boston Globe Health Section interview, which ran July 6. Tama won the Alliance’s “Home Health Aide of the Year” Award for her outstanding work and tells some of her story in the article.

Click here to see the Globe’s interview with Tama Lewis. See a clip from the story below:

The pay is low, and the clients can sometimes be grouchy. Still, Tama Lewis says she’s found her calling. Out of thousands of candidates, the 64-year-old Randolph woman recently was chosen Aide of the Year by the Home Care Alliance of Massachusetts for her unflappable personality, insightful nature, warmth, and tact in caring for home-bound patients.

Return to www.thinkhomecare.org.

Providence (RI) Business News: Advantages, Barriers to Physician Use of Home Health Services

The recently released survey conducted by the Massachusetts Medical Society, in collaboration with the Home Care Alliance, was covered in a July 6 story by the Providence Business News.

Click here to see the story and check out the Alliance News Feed to see the results of the MMS survey.

Some of the higlights include:

Advantages: The main advantages to home services cited by physicians were better compliance with the patient’s care plan (78% of respondents), reduced stress on caregivers (73%), improved coordination of care (65%), and fewer visits to emergency departments (63%). An overwhelming number of physicians – 97% – say the services help them better manage their patients’ care at home.

Barriers: The main barriers to using these services cited by physicians were administrative burdens (paperwork, 54%), reimbursement issues (40%), and availability of workers (33%). The barrier of reimbursements, however, appears to be one that can be readily fixed by education and information: of the 71% of physicians who reported that they did not submit charges to Medicare for the services, 64% of those said they were unaware of the reimbursement.

Reduced Stress on Caregivers: The benefit of reducing caregiver stress by using these services was cited by 73% of physicians – an important consideration as more and more family members are pressed into caring for their elders for longer periods of time. According to the National Alliance for Caregiving, an estimated 44 million Americans age 18 and older – about 21% of the population – provide unpaid care to another family member. And recent surveys and published reports have indicated the economic recession has put further strain on caregivers: as services are cut, caregivers are carrying much more of the financial load for care and in many cases are dividing time between working and caregiving.

Return to www.thinkhomecare.org.

Survey Results: Physician Perceptions, Use of Home Health Services

A Massachusetts Medical Society survey, performed in collaboration with the Home Care Alliance, has shown that a vast majority of physicians believe home health care services provide multiple advantages in improving health care quality and reducing costs without compromising outcomes, but administrative burdens, reimbursement issues, and lack of access to the services are regarded as main barriers to using these services.

Click here to see the full results of the physician survey.

Advantages: The main advantages to home services cited by physicians were better compliance with the patient’s care plan (78% of respondents), reduced stress on caregivers (73%), improved coordination of care (65%), and fewer visits to emergency departments (63%). An overwhelming number of physicians – 97% – say the services help them better manage their patients’ care at home.

Barriers: The main barriers to using these services cited by physicians were administrative burdens (paperwork, 54%), reimbursement issues (40%), and availability of workers (33%). The barrier of reimbursements, however, appears to be one that can be readily fixed by education and information: of the 71% of physicians who reported that they did not submit charges to Medicare for the services, 64% of those said they were unaware of the reimbursement.

The survey also touched on the potential to reduce caregiver stress and also the disparity in home health usage by primary care doctors versus specialists.

Return to www.thinkhomecare.org.

Pamphlet: Using Home Oxygen Safely

The Commonwealth of Massachusetts’ Department of Fire Services has released a pamphlet geared towards patients, families, doctors, nurses, therapists and first responders regarding safe use of oxygen in the home.

You can download the pamphlet by clicking here, which contains useful information for your staff and their patients. For more information about the Department of Fire Services’ campaign to educate patients, families and health care workers on safe home oxygen use, visit the DFS website, “Breathe Easy: Use Home Oxygen Safely,” by clicking here.

Return to www.thinkhomecare.org.

Health Leaders Media: Study of Physicians Use of Home Health Services

A  survey conducted by the Massachusetts Medical Society in collaboration with the Home Care Alliance has shown that a vast majority of physicians believe home health care services provide multiple advantages in improving health care quality and reducing costs without compromising outcomes, but administrative burdens, reimbursement issues, and lack of access to the services are regarded as main barriers to using these services.

Health Leaders Media wrote a story on the study results that came out July 1st, an excerpt of which can be seen below. You can read the entire article by clicking here.

Slightly more than half of the doctors who responded to a physician survey in Massachusetts last fall said they kept patients in the hospital longer than necessary because of a lack of access to home health services, according to a new report.

But most of the doctors said they were aware that use of such agencies can safely reduce days of hospitalization and their cost as well as emergency room utilization, an increasing priority in the health reform agenda.

Return to www.thinkhomecare.org.