Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

Modernizing the Medicare Home Health Benefit—at Last

Please help us advocate for The Choose Home Care Act, which would provide eligible recipients with SNF-like levels of care at home for 30 days post hospital discharge.

Last week, legislation was introduced in the US Senate that would provide the most significant update to the Medicare home health benefit since its inception. A strong bipartisan group of senators filed the Choose Home Care Act, which would provide eligible recipients with SNF-like levels of care at home for 30 days post hospital discharge. Services would include not only traditional nursing and therapy, but also meals, personal care, remote patient monitoring, and non-emergent transportation, if needed.

A study commissioned by NAHC and the Partnership for Quality Home Health care estimates that the Choose Home Care program could generate Medicare annual savings of $144-247 million with $1.6-2.8 billion in savings over 10 years. NAHC President Bill Dombi called this “must pass” legislation. So, we have a bipartisan bill that could save Medicare dollars, with support from AARP and others in the aging advocacy networks. Sounds like a slam dunk. But this is DC, so there are no such things.

Contact Your Senators

While the advocacy focus is currently on the Senate bill, I hope that when the House acts, Massachusetts can lead the way and get our full delegation on board. Please help Choose Home and send a message to our two senators.

Behavioral Adjustments Under Early PDGM

NAHC’s Bill Dombi replies to reports that patients across the country are being told they no longer qualify for certain Medicare services or that services have been cut or discontinued.

Kaiser Health News and other health care media outlets are reporting that patients across the country are being told they no longer qualify for certain Medicare home health services or that services have to be cut back or discontinued due to changes in Medicare scope of benefits.  On a call with state home care association executives this week, Bill Dombi, President of the National Association for Home Care and Hospice confirmed that they are hearing of such cases from patient advocacy groups, such as the Center for Medicare Advocacy.  If such behavior gives the industry “a reputation for putting bottom line ahead of patient care, it’s going to be bad long term for the home care industry,” said Dombi.

In terms of any shortcoming with the PDGM model, he said,  we want to be able to lay these at the feet of the model’s crafters at CMS, not having them come back at us for over adjusting behaviors even beyond what was built into the model. He further suggested that until proven otherwise it might be case of managers and field staff inaccurately translating direction from management as to what has changed. He suggested CMS might need to do some more education around what has changed (payment) and what has not (coverage).

NAHC will present a series of six new webinars – free to members and non-members – on PDGM in Real Time featuring an open forum in which attendees can share and gain insights with Home Care & Hospice Financial Managers Association (HHFMA) experts about what is working and not working in the early weeks of PDGM.

These webinars are designed to enable home health agencies to achieve “high performer” status through continuous operational improvements in financial, clinical, business analytics, and administrative operations as PDGM unfolds.

The schedule for the “Wednesday webinars at 1 PM ET” is as follows:

  1. February 12 at 1:00 PM ET Info Tech/EMR readiness
  2. February 19 at 1:00 PM ET PDGM coding
  3. February 26 at 1:00 PM ET PDGM cash flow & LUPAs
  4. March 4 at 1:00 PM ET Therapy in PDGM
  5. March 11 at 1:00 PM ET Clinical management of patient episode
  6. March 18 at 1:00 PM ET PDGM data analytics

Registration information can be found here.

Announcing our “Home, Not Alone” Speakers Bureau Campaign

The Alliance’s Home Care Speakers Bureau can bring presentations on careers and other subjects to nursing schools, job fairs, or student assemblies.

Health care is moving out of the institutional setting and into people’s homes. Nursing and other allied health professional positions are following a similar path as the percentage of nurses moving into work a in hospital setting continues to decrease annually. Yet, newly graduated nurses often leave school not having been exposed to the nursing opportunities and high degree of complexity and independence in home health care practice.

Our Home, Not Alone campaign seeks to drive interest in, and confidence about, making a nursing career in home care or hospice.

Visit the Speakers Bureau

Our dedicated speakers will bring presentations on careers and other subjects to nursing schools, job fairs, or student assemblies. Here is just a snippet of a presentation:

For more information about the program, visit the Home Care Speakers Bureau on our website.

Request a Speaker

Combating Loneliness, Making a Difference

In home care, we see how debilitating loneliness can be to patients and clients. One local organization, FriendshipWorks, is looking to light candles in the darkness of social isolation.

So much of what we are about in home care is connecting those who might otherwise go without it to the care they need. Every home care nurse, therapist, or aide has been in a home where she/he might be the only person that patient/client has seen in days. We see loneliness, and we see how debilitating it can be.

Many studies have proven what a home care nurse knows from first-hand observation: Loneliness can be bad for someone’s health. On a national level, AARP has recognized what its  medical director, Dr. Charlotte Yeh, calls the “power and presence of loneliness” in its Connect2Affect campaign.

Through some of our home care colleagues, I have recently been introduced to one local organization looking to light candles in the darkness of social isolation. For 35 years, FriendshipWorks has been training volunteers to provide companionship and emotional support to older adults across Greater Boston. They provide what more than one study has called “The Healing Power of Presence.”

Considering how the organization’s volunteers accompany their older friends to critical medical appointments, FriendshipWorks is a vital resource for many of Boston’s academic medical centers.

Matt Fishman, Vice President for Community Health at Partners HealthCare, sees the difference FriendshipWorks volunteers make. “While it may be less quantifiable than some of our other metrics impacting patient outcomes and healing, we can see the reduced anxiety associated with having someone to take you and be there with you for a medical appointment, especially when you might be receiving a difficult diagnosis or set of instructions,” Matt says. That a less-anxious patient is definitely a patient more able to engage and have a quality experience, is central to the work of Christine Dempsey in “The Antidote to Suffering.”

Experienced home care executives, Andrea Cohen, Founder and CEO of HouseWorks, and Denise McQuaide, President and COO of Benchmark Wellness Management (formerly, president of Care Group Parmenter Home Care & Hospice), are co-hosting a 35th anniversary event on Nov. 21 to support FriendshipWorks. If you would like to get on board this important cause and enjoy the great entertainer Darlene Love in an intimate setting, you can get all the info you need here.

Any ideas or experiences about the interest of loneliness and health and healing, send them along to me. Happy to continue to share.

Mobile Integrated Health and Community EMS: An Update

At the most recent HCA of MA Board of Directors meeting, Scott Cluett, Director of the DPH Office of Emergency Medical Services provided an update on the role out of Mobile Integrated Health and Community EMS in MA. Both programs were created by a 2015 act of the MA legislature, following a trend in many states to use EMS personnel to deliver care outside of the emergency transport role. Applications for MIH programs were released in December 2018, with a few coming online mid 2019. MIH programs must, in their applications: “identify and validate one or more gaps in service delivery using data and a corresponding community health needs assessment. Each application must also describe how the proposed MIH program will address identified gaps in service delivery and provide improvements in quality, access, and cost effectiveness, an increase in patient satisfaction, improvement in patients’ quality of life, and an increase in interventions that promote health equity, including cultural and linguistic competencies…”Coordination of care is explicitly required with MIH applicants either having named health care partners or a plan for primary care coordination.

Community EMS programs must be founded in partnership with a local municipality and focus on prevention if illness or injury. So far 11 cities and towns have launched programs with the most common services offered being fire burn prevention and education, home safety evaluations, sharps awareness (and at least in one community sharps disposal) and naloxone training.

The change in state law that allows EMS personnel to treat in lieu of transfer is just beginning to be understood. How it may be incorporated into home care and hospice patient care management remains to be seen. Cluett’s short presentation, along with the pertinent regulations, can be found here.

Return to www.thinkhomecare.org.

Advocate and Engage on PDGM

There are many ways that home health agencies will need to prepare their agencies for the radical changes coming from PDGM in January 2020. The Alliance is here to help.

Last month, the Centers for Medicare & Medicaid Services (CMS) issued its proposed rule for 2019 home health payment rates and policy changes, which includes significant provisions that will impact your organization, staff, and the patients you serve.

Between now and when the Patient Driven Grouping Model (PDGM) goes into effect on January 1, 2020, there are multiple ways that home health agencies will need to prepare their agencies for the radical change. (See Coding and Billing webinars coming in September, at the bottom of this page) At the same time, home care must take action to mitigate the impact of what PDGM will look like and how it will impact organizational viability.

Home care’s collective advocacy efforts have undeniably made a difference in the past, including putting a stop (at least in Massachusetts) to the Pre-Claim Review Demonstration and scrapping the Home Health Groupings Model thanks to more than 1,200 comments submitted to CMS last year. The more that CMS and lawmakers hear from home health professionals, the better our chances are at reducing the severe cuts that accompany PDGM in its proposed form.

As currently proposed, the 2020 rule will:

  • Reduce the Medicare base rate by 8.01% next year, which amounts to a $1.298 billion reduction in home health payments in 2020 alone. CMS proposes the reduction to account for anticipated changes in provider behavior that are unrelated to changes in patients served or services delivered that increase payments. This newly proposed “behavioral adjustment” reduction is up from the 6.42% reduction that CMS initially proposed, and the reduction would start before any actual behavioral changes occur.
  • Phasing out RAPS over 2020 with total elimination of RAPs in 2021. Next year, CMS proposed reducing RAPs from 60/50% to 20% for existing home health agencies (HHAs), while new agencies would get no RAP. CMS claims that RAPs create fraud risks.
  • Starting in 2021, a Notice of Admission (NOA) must be submitted Notice of Admission must be submitted within five days of the start of care. For every day late, CMS plans to reduce base-rate reimbursements for the unit of care.

The Solution: Pass S.433/H.R.2573

This month, Congress is in recess and back in the states, which presents a pivotal opportunity for home health industry professionals to engage with lawmakers about a key legislative priority – the Home Health Payment Innovation Act (S.433/H.R.2573).

This legislation prohibits CMS’s ability to adjust payment based on “behavioral assumptions” as opposed to observed evidence of behavioral changes, thus rescinding the proposed 8.01% adjustment.
Additionally, this important legislation would:

  1. Achieve full budget neutrality over the period of 2020-2029.
  2. Require behavioral adjustments based on real, actual changes in provider behavior in response to the new payment model.
  3. Permit a phase-in of rate adjustments (up or down) when an annual adjustment would be greater than 2 percent. However, the phase-in would operate to ensure full budget neutrality by 2029.

Email your Members of Congress

It’s not too late to get members of Congress informed and engaged on this important legislation. You can send an email directly from HCA’s member advocacy center.

At this point, Congressman Jim McGovern is the only member of the MA delegation signed on as a cosponsor. We must do better.

Fact Sheet: Senate 433 & HR 2573

Advocate in Person

Join home health industry advocates next month in Washington, D.C. for The Council of State Home Care Associations’ Third Annual Public Policy Summit and Advocacy Day!  On September 9, participate in a full-day summit featuring speakers including Hillary Loeffler, Director of the CMS’ Division of Home Health & Hospice.  On September 10, we be on Capitol Hill meeting with members of Congress to convey the critical need to pass S.433/H.R.2357.

Program details can be found here and registration information can be found at The Council’s website.

Submit Comments to CMS by September 9

Click here to submit comments to CMS in response to the 2020 proposed rule by 5:00 PM ET on Monday, September 9, 2019.

HCA and other industry organizations will provide more thorough comments on other problematic areas of the proposed rule. As previously stated, there is strength in numbers, so the more business-focused comments from providers – both large and small – are critical to giving CMS a full and clear picture of how devastating PDGM will be should it be implemented as proposed. Watch Update for draft comments.

Return to www.thinkhomecare.org.

Patient Legal Advocates

Information for clients/patients needing legal assistance around lost benefits or insurance.

The movement of many insured into “managed” environments has resulted in some questions to the HCA of MA regarding clients’ rights should home care services be terminated or suspended. Every Managed Care Organization (MCO) or Accountable Care Organization (ACO) – be they serving Medicare or Medicaid clients – has an obligation to have some form of patient (although not necessarily agency) internal appeal process. Agencies who are working with these organization should be versed in what these processes are.

For clients for whom the changes are threatening their well being, or seemingly discriminatory, or based on a pattern of inappropriate clinical decision making, there are legal services entities in this state who may be able to help. This list includes their names and contact information. Please note: these legal services entities will generally only take up a case if a client or, in some cases, a family member of a client calls. Keep this information on hand and share with any client who may need assistance.

Return to www.thinkhomecare.org.

Annual Report – Message from our President

Annual Report: Message from the President of HCA of MA

Last month HCA of MA published our Annual Report to members.  Below is the opening message from our President.

To the Members:

“The world is changed by your example, not by your opinion.”

This year HCA of MA is celebrating 50 years as a membership driven trade association advocating with and on behalf of home care agencies, and home care patients.

It is very humbling to be Board Chair during such a milestone year. As many Board chairs before me have done, I have learned from the example set by those that have come before me, that includes both my immediate predecessors, such as Holly Chaffee and Wayne Regan, and those that came before them.  They all instinctively knew that you can’t ask of others what you are unwilling to do yourself and that waiting around for somebody else to do it is a sure way to assure that nobody does it.

As I look back at the year as laid out in this report, I see so much that we can be proud of as a member dedicated organization.  As President for a second term, I will work hard to make sure that continues. As our diverse members – each in their own way – struggles with the human resource, funding, marketing/image and regulatory issues, I want us not to lose site of some very big picture indisputable facts, including:

  • The demographics of our aging population will continue to demand new and more creative approaches to chronic care, serious illness and population health management and home care is the industry to provide these,
  • Home Care is where the professional and paraprofessional health care jobs will be increasingly moving to, and
  • All indications are that patients and families want and are satisfied with the services our member agencies provide.

When we lead by example and build on these certainties, we cannot help but be successful.

Thank you for your confidence.

Maureen Bannan
President

Report on the Massachusetts Serious Illness Coalition

The MA Serious Illness Coalition pushes to bring awareness and focus on end-of-life issues.

“It is my goal that every nursing school in MA embrace that a nursing student must see a dying patient with the same fervor that they embrace that every nurse must see a baby being born.”
— Susan Lysaght Hurley, PhD, RN
Director of Research, Care Dimensions, Inc

Last week, the Massachusetts Serious Illness Coalition hosted its annual meeting welcoming more than 100 attendees to the JFK Library in Boston. The message from the Coalition’s leadership – as articulated by Blue Cross Blue Shield MA President and CEO – is that “the momentum is building.” From the Coalition’s beginnings less than five years ago, Dreyfus has focused on a long-term strategy to achieve the Coalition’s six goals. These include the ideas that everyone in Massachusetts 18 years or older has a designated health care decision-maker and that all Massachusetts clinicians have appropriate training to communicate comfortably with patients around advanced care planning and serious illness. Dreyfus has likened the work to that done in years past on smoking and on car seats, where steady force and public messaging achieved near-universal changes in public thinking.

The progress on clinician education – from a provider association perspective – is perhaps the most engaging and encouraging news. Dr Atul Gwande, as eloquent as ever, declared that the work to date has shown that: “People have priorities in life beyond just surviving, but you must ask them. Suffering happens when care doesn’t match our priorities.”

In addition to a public education campaign about engaging in advanced care planning conversations, Dr. Gwande announced that the Coalition is in talks with all four Massachusetts medical schools about a cooperative effort to require training of med students in serious illness communication as a graduation requirement.

But it was Dr, Hurley’s remarks that struck home for the home health and hospice agencies in the Coalition. In addition to the above comment, Dr. Hurley spoke of being a young nurse “totally unprepared as to how to talk to the dying.” Along with her subcommittee co-chair Anne Marie Barron of Simmons College, she is working on recommendations on core competencies for nursing education related to serious illness care. These are to be presented in the near future to the Massachusetts Association of Colleges of Nursing. What a great achievement that would be!

For those following the Coalition’s work, these may also be of interest:

  1. End Games, an Academy Award-nominated short documentary on hospice and palliative care executive produced by Shoshana Ungerleider, MD. It premiered at Sundance Film Festival in 2018 and was acquired by Netflix.

2. The Coalition’s public message research and draft public facing marketing approaches.

Commendable progress!

Return to www.thinkhomecare.org.

Get “Woke” on Sepsis

Several new resources are available to members to help them combat one of the most dangerous health conditions in the Commonwealth: Sepsis.

Massachusetts Sepsis ConsortiumSepsis: A public health challenge of enormous proportions, a top driver of health care costs, and a condition that kills more people each year than cancer. But when recognized and treated swiftly, sepsis can be stopped before it causes significant health damage.

The statistics are sobering: Approximately 42,000 Massachusetts residents are diagnosed with sepsis every year and an estimated 5,000-7,000 of them die from the condition. Sepsis is consistently among the top causes for 30-day hospital re-admissions in all regions of Massachusetts and is the third-leading cause of hospital inpatient deaths in the state. And yet, Massachusetts is only a middling performer on sepsis indicators, ranked 25th in mortality in 2017 and at the national average in providing timely care for patients with sepsis.

Providers and policy makers have come together as the Massachusetts Sepsis Coalition – under the umbrella of the Betsey Lehman Center for Patient Safety – to bring more resources to bear in terms of understanding, identifying, and treating sepsis. The Coalition’s initial task force assessed the current state of sepsis response in hospital emergency departments and just recently released their extensive report, with recommendations.

Because 80% of sepsis cases are thought to originate outside the hospital, the home care community is beginning to examine our own understanding of, and training around, sepsis identification. A year or so ago, the Home Care Association of New York State developed their “Stop Sepsis at Home” campaign and tool kit. The Home Care Alliance of MA presented this to our members on several occasions, including at last year’s annual Spring Conference and Trade show.

On May 14th, 2019, the Alliance will host – along with Healthcentric Advisors – a free Train the Trainer session on Sepsis Awareness in the home setting. All members are encouraged to send someone. Agencies who cannot attend can find sepsis resources below.

Return to www.thinkhomecare.org.