Author: James Fuccione

Palliative, End-of-Life Care Options Regulation Finalized

A provision  included in the state’s 2012 Health Care Cost Containment Law (Chapter 224) on palliative and end-of-life care options is being realized through a final regulation issued by the Department of Public Health.

It is now a patients legal right to receive information about palliative care and hospice from a facility as well as their full range of options for treatment, if the condition warrants either approach. Massachusetts hospitals, clinics and long-term care facilities are expected to comply.

The Home Care Alliance helped advocate for the inclusion of this provision in the law and also commented with several other provider groups and organizations at a public hearing when the regulations were proposed. At that time, the definition of palliative care in the proposed regulation was more in line with hospice services. The Alliance, among many other groups, expressed concern that palliative care is a team-based approach to an advanced illness, but not necessarily linked to the expected outcome of that illness as with hospice.

DPH has released a guide explaining the right to these options in several languages for consumers, a summary of what was changed from the proposed to the final regulation, and the regulation language itself. The list of resources can be viewed here on a DPH webpage.

Return to www.thinkhomecare.org.

HCA Ad Campaign with CBS-Boston Underway

Thanks to the sponsorship of six Alliance members, the HCA’s shared advertising campaign is off and running through the months of December and January.

AllCare VNA & Hospice, Circle Home, CareTenders, Comfort Keepers, Home Instead Senior Care and South Shore VNA will be featured on WBZ-TV and WSBK-TV as well as on the CBS-Boston website in certain areas of the state. Viewers will see shared ads from these six agencies and the Alliance along with a PSA featuring tips on choosing a home care provider.

The video clips of these ads are available below:

Ad 1: CareTenders – Comfort Keepers

Ad 2: Circle Home – South Shore VNA

Ad 3: All Care VNA – Home Instead Senior Care

Home Care Alliance Healthwatch PSA

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HCA Blasts Governor for Pulling MassHealth Rate Increase

After years of working with MassHealth on an update to home health care payment rates, and after learning that the rate increase was set, the Governor pulled the payment boost as part of his recent budget-balancing plan.

The Home Care Alliance delivered a letter to the Governor blasting the decision as part of a “failure to recognize home health care as a vital part of the health care continuum.” The letter noted that rates have not been increased since 2007 and were cut in 2008 for some of the state’s most vulnerable patients that receive home health care services. At that time, payment was cut by 20 percent for services lasting beyond 60 calendar days of care. This, according to the letter, essentially means that “agencies are being reimbursed in 2014 at rates set in 2007 and cut in 2008.” Moreover, the rates were already well below the cost of providing care that brings MassHealth savings by preventing or delaying costlier facility-based care.

Part of the hand-off to incoming Governor-elect Charlie Baker was to slash a state budget deficit of $239 million. From that amount, $68.5 million came from MassHealth services. Although MassHealth home health services were not directly cut, the payment rate being pulled was a blow to agencies and advocates that heard only a week earlier that the rate increase was set for March 1, 2015.

The administration had planned for a $8 million increase, although it was unclear how that funding was going to be implemented.

“Due to recent revenue shortfalls, agencies across state government were required to make difficult choices in order to maintain a balanced budget,” said Health and Human Services spokesman Alec Loftus in a statement to State House News Service. “We took a thoughtful approach to ensure that our most critical programs that help children, families, veterans and our most vulnerable populations are protected.”

As with 2008, the “thoughtful approach” did not include the cost-efficiency home health services bring to the table. Nor does it take into account the money agencies lose every time a nurse goes to a patient’s home to provide care because the cost of providing services far exceed reimbursement.

The Home Care Alliance will continue to make MassHealth payment a policy priority through the state budget process.

Return to www.thinkhomecare.org.

New England’s Senators Urge Action on ‘Face-to-Face’ Concerns

US Senators representing the New England states have stepped in to send a letter to CMS regarding the onerous medical review process relative to the Physician Face-to-Face Requirement being undertaken by National Government Services (NGS), which is the Medicare Administrative Contractor (MAC) for the region.

The state home care associations in the region, including the Home Care Alliance, worked together to draft the letter, gather data, and mobilize agencies to ask that Senators sign on to the letter.

The letter to CMS Administrator Marilyn Tavenner convey that the reviews and unjustified claim denials could “jeopardize seniors’ access to home health care” and that any measures meant to attack fraud and abuse should be clear, consistent and not threaten a beneficiary’s ability to receive needed care. The letter also highlights that, in some cases during 2014, withheld and denied reimbursements have exceeded the cost of a two-week payroll for some agencies.

While acknowledging the CMS final rule that changes the Face-to-Face Rule’s narrative requirement, the letter urges the following:

  • Explain what additional steps CMS will take to better ensure the clarity of the F2F regulations to prevent any further inconsistent denial of claims across the country;
  • Describe how you will ensure that patient care will not be compromised while the appeals of F2F denials are being considered;
  • Provide us with a current list of the outcomes of Medicare home health F2F denials and appeals across the country; and
  • Consider the feasibility of working with home health agencies to reopen or settle claims related to F2F in a manner that is equally fair to both taxpayers and home health providers.  Such considerations could include analysis as to whether an agreement similar to the administrative agreement process recently offered by CMS to hospitals that have a high volume of backlogged claim denials would be appropriate for backlogged home health claims related to F2F.

Nine of the twelve US Senators representing the New England region signed on, including both Massachusetts Senators Elizabeth Warren and Ed Markey. The Alliance thanks them for their continuing support of home health care issues and particularly efforts to improve the Physician Face-to-Face Requirement.

Return to www.thinkhomecare.org.

Home Care Impacted by Governor’s Budget Cuts

With a new Governor coming into office in January and a $329 million budget shortfall, the Patrick Administration was forced to make reductions to close the deficit.

A large chunk of those cuts came at the expense of MassHealth, which makes up slightly more than half of the state’s $36.5 billion fiscal year 2015 budget. MassHealth officials contacted the Home Care Alliance to report that $68.5 million in reductions had to come from MassHealth alone and that a rate increase for home health agencies is no longer on the table for FY15.

The Home Care Alliance had seen hints that there finally would be a review of MassHealth home health care rates after years of being passed over. Rates were frozen in 2007 and one of the Patrick Administration’s first cuts were from home health services past 60 calendar days of care. The rate inexplicably dropped by 20 percent for patients who require longer-term home health care and that cut has not been revisited.

Also cut was $1.52 million from the Elder Affairs’ “Home Care Purchased Services” line item that will go into effect on December 1st at which time the waiting list for Aging Service Access Point (ASAP) services could go back into effect. Officials from Elder Affairs indicated the lowest priority level would be the only one impacted, which preserves those in the greatest need for care.

The bright spot is that the Home Care Alliance’s efforts to gain MassHealth reimbursement for telehealth provided by home health agencies is not impacted and plans to implement rates and guidelines is going on as planned. Moreover, home health rates are, more or less, remaining status quo and are not being reduced further. Nursing Home Supplemental Rates, for example, were slashed by $9.1 million.

A rate review for home health services remains a top priority and the HCA will continue to work with the legislature and MassHealth on improving payment.

Return to www.thinkhomecare.org.

Boston Globe Names HCA Member Agencies as ‘Top Places to Work’

Home care is a tough and rewarding career, but now working for a home care agency could be one of the best places to be employed in general.

Several Home Care Alliance member agencies made a strong showing on the Boston Globe’s “Top Places to Work 2014,” where employee satisfaction surveys are used to judge how well companies treat their workers. This methodology propelled four agencies to be recognized on the annual list.

Comfort Home Care earned the top spot under the “large employer” category with an employee amount between 250 to 999.

In the “mid-size” company rankings with an employee number between 100 and 249 workers, three home care agencies made the list: Visiting Angels of Newton and Canton (#6), Able Home Care (#22), and Community Nurse & Hospice Care (#31).

Among the survey statements are the following:

■ Direction: “I have confidence in the leader of this company.”

■ Execution: “New ideas are encouraged at this company.”

■ Connection: “My job makes me feel like I am part of something meaningful.”

■ Management: “My manager cares about my concerns.”

■ Work: “This company encourages different points of view.”

■ Pay and benefits: “My pay is fair for the work I do.”

■ Engagement: “This company motivates me to give my very best at work.”

The Globe invited 1,660 companies to participate in the 2014 Top Places to Work survey. Of those, 366 organizations employing more than 336,000 people went all the way through the process, allowing the Globe to conduct a confidential survey of their workers.

The Home Care applauds the agencies in the “Top Places to Work” ranking and all agencies that keep people healthy and independent at home.

Return to www.thinkhomecare.org.

Join HCA in Celebrating National Home Care and Hospice Month

Each November, the Home Care Alliance joins agencies and organizations across the state and the country to celebrate National Home Care & Hospice Month by raising awareness of the value of home-based services and recognizing the clinicians and aides that deliver those services.

The Alliance is promoting a special Home Care & Hospice Month webpage with useful information for consumers explaining home care and how to find the right provider for a loved one or friend. The website also has info for home health and home care agencies about how to promote and celebrate the month-long event.

Especially useful for consumers is the “Home Care FAQ” page on the Alliance’s Home Care & Hospice Month website. Not only does this resource address questions like “How do I pay for Home Care?” and “How do I assess my needs?,” but also provides a list of questions for consumers to ask home care agencies. That way, consumers can be sure they’re getting the best possible care for themselves, a loved one or friend.

Social media is a big part of the HCA’s awareness campaign so the Alliance is asking that any agencies with clinicians or aides they would like to recognize can send a photo to James Fuccione with the person’s name and title so we can spotlight them on our Facebook page.

If your home care or hospice agency has any events or activities being carried out this month for the event, please let us know via Facebook and twitter (@thinkhomecare).

If you are a consumer, be sure to check out our Home Care & Hospice Month webpage!

Return to http://www.thinkhomecare.org.

CDC, Mass DPH Release Updated Ebola Guidance for Healthcare Workers

On October 20th, the federal Centers for Disease Control and Prevention (CDC) released stricter guidance on Personal Protective Equipment (PPE) recommended for healthcare workers treating patients with the Ebola virus.

The new enhanced guidance from CDC is centered on three principles:

  • All healthcare workers undergo rigorous training and are practiced and competent with PPE, including putting it on and taking it off in a systemic manner
  • No skin exposure when PPE is worn
  • All workers are supervised by a trained monitor who watches each worker putting PPE on and taking it off.

These principles and other guidance listed on the new advisory appear to be geared towards healthcare facilities and are based on lessons learned from those hospitals and clinics that have treated Ebola cases in the US thus far, including Emory University Hospital, Nebraska Medical Center and National Institutes of Health Clinical Center.

Also on October 20th, the Massachusetts Department of Public Health (DPH) and Boston Public Health Commission released updated clinical guidance on sending in patient specimens for laboratory testing for suspected Ebola cases. According to DPH, prior to sending a sample, the facility should consult the MDPH Hinton State Laboratory Institute for specimen collection, handling, packaging and transport advice via the 24/7 lab number (617-590-6390).

More information will be shared as it becomes available.

Return to www.thinkhomecare.org.

MA Cancer Prevention & Control Network Readying Palliative Care Survey for Home Care

The Massachusetts Comprehensive Cancer Prevention & Control Network (MCCPCN) is putting the finishing touches on a survey on palliative care geared towards treating cancer patients.

The Home Care Alliance is a part of an MCCPCN task force that built the survey, which will be distributed to agencies via email form DPH.  Agencies are strongly encouraged to take the time to respond. MCCPCN is under the Department of Public Health and a cover letter from Commissioner Cheryl Bartlett explains the reasoning and background to the survey as well as how it will help advance palliative care services.

Questions on this issue can be directed to James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

 

Ebola Preparedness Info and Resources Released by DPH

Through press conferences and announcements, state officials have repeatedly stressed that the likelihood of an Ebola case is Massachusetts is “very low,” but that does not mean local healthcare providers should not be prepared and the general public should not be educated on the issue.

The Massachusetts Department of Public Health has posted information and resources on a special webpage  with guidance for clinicians and other helpful information. Misinformation about the disease has caused some of the concern, but the state continues to monitor the situation.

Here is part of a recent Public Health Advisory:

Massachusetts is well prepared to handle an incidence of Ebola, in the unlikely event that a case should occur in the Commonwealth. The public can have full confidence that our hospitals have the expertise, preparedness and capacity to handle such a situation. The infectious disease controls in Massachusetts and the United States are world class. Should a patient present Ebola symptoms, the patient would be quickly isolated and treated to prevent the spread of this disease.

Please see the resources below that are listed on mass.gov/dph/ebola.

DPH Guidance for Clinicians

General Information About Ebola Virus

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